Tom Harkin

Mr. HARKIN

Mr. HARKIN. Mr. President, I come to the floor today, to congratulate students from Central Academy High School in Des Moines, IA, who competed in national finals of the ``We the People: The Citizen and the Constitution'' program in Washington, DC, earlier this month. The students won the Unit Three Award at the competition. This was the second year in a row that students from Michael Schaffer's government classes have won this prestigious recognition. These outstanding young Iowans competed against classes from every State in the country, and earned the highest score by demonstrating a remarkable understanding of the fundamental ideals and values of American constitutional government. Clearly, the future of democracy is in good hands, as demonstrated by the skill, knowledge and poise shown by these students. I recognize and salute the students from Des Moines and surrounding suburbs who were involved in the competition: Emily Burney, Julia Busiek, Kate Conlow, Tim Di Iulio, Jon Hill, Lisa Jefferson, Alix Lifka-Reselman, Phillip R. Miller, Ben Miller-Todd, David Nolan, Caroline Rendon, Andrew Tatge, Erin Turner, Emily Yarn. The ``We the People'' program is administered by the Center for Civic Education. It is the most extensive program of its kind, reaching more than 26 million students in elementary, middle, and high schools. In Iowa, ``We the People'' is coordinated by Linda Martin and Ivette Bender is the district coordinator for the area that serves Des Moines. I salute them also for their hard work and dedication to this excellent program.

Mr. HARKIN

Mr. HARKIN. Mr. President, I yield myself such time as I may consume. I rise today to speak about the prospect that at some point next week, according to all of the press reports and according to what I have heard on the floor, the majority leader of the Senate will take a course of action that has been dubbed the ``nuclear option.'' The majority leader will take a course of action that will tear down the rules by which we operate in the Senate, rules which have been laid down in some cases for almost 200 years, in some cases over 100 years. I believe we should be taking our time in the Senate because of the effects that this step by the majority leader could have on how we represent our constituents. It can have such a profound effect that it behooves us all to think very deeply and carefully about it and to come to the floor to express our opinions. By triggering this nuclear option, the majority leader would unleash forces he would regret and that everyone who loves this great Nation and its system of checks and balances would regret. There is no question that by breaking the rules--that is what would happen, breaking the rules--the majority party would gain short-term advantage. They would be able to confirm every one of their judicial nominees, no matter how radical or out of the mainstream. But the long- term destructive consequences triggering the nuclear option would be profound for our system of Government. For more than two centuries, Senate rules and traditions have respected the rights of the minority. That would be destroyed. For more than two centuries, thanks to those minority rights, the Senate has been a force for compromise, moderation, and reason. That would be destroyed. For more than two centuries, the minority's power in the Senate has been essential to America's system of checks and balances. That would be destroyed. And something else of great importance would be destroyed: Respect for rules. Playing by the rules is the American way. It is one of our core values. From childhood, we are taught to respect the rules, to follow the rules, to play by the rules. We are taught it is dishonorable to break the rules or to change the rules in the middle of the game, especially to gain an advantage or simply to win. Ask any child, and he or she will say that breaking the rules or changing the rules in the middle of the game is not only unfair, it is wrong. America is a great country because playing by the rules and respecting rules is a core value. It is a way of life. It is at the heart of our athletics, our business dealings, our way of government. It is no exaggeration to say that if one destroys the idea of playing by the rules, then they invite distrust, disorder, and the disintegration of the American social fabric. They invite chaos, and chaos invites tyranny. This is exactly why the Republican leadership's plan to resort to the nuclear option is so dangerous. Since 1790, the filibuster has been used in the Senate countless times, and nearly 100 years ago the Senate passed rule XXII, codifying the right of extended debate. We know what that rule says. It says that it takes 67 votes to change the Senate rules and 60 votes to cut off debate. Those are the rules. They are deeply conservative rules, rules that have been respected and honored for nearly a century, until now. The Republican leadership is unhappy because a small number of judges, all of them I consider far out of the mainstream, have been filibustered by the minority. They are unhappy because they have been able to confirm only 95 percent of the President's judicial nominees and not 100 percent. This compares to only an 80-percent confirmation rate during the Clinton administration. The Republicans blocked 68 Clinton judicial nominees, including, I might add, Bonnie Campbell, from my State of Iowa. Most of those nominees were blocked in the Judiciary Committee by just one Senator. Now, does the Republican leadership celebrate the fact that by playing by the rules they won 95 percent of the time? Do they now play by the rules and gather the votes necessary to change rule XXII governing filibusters? No. They are going to employ a trick, a procedure, whereby the rules are overturned by one decision of the Presiding Officer backed by 51 votes. That will destroy the rules of the Senate. Now they say: Well, it only applies to judges now. It can apply to anything else down the pike. Now, a mere 10 Bush nominees have been blocked, and what is the Republican leadership's response? It is to destroy the rules. Sweep aside more than 200 years of Senate tradition. In its place, they will make up their own rules, a new rule, that will allow them or any majority to change any rule at any time for any reason with only 51 votes. In other words, once the nuclear option is detonated and a new Senate precedent is established, this body will be subject to the whim of any group of 51 Senators who want to impose their will without any provisions for extended debate. Make no mistake, this will be the end of the Senate as we know it. How ironic that this is being done by Senators who call themselves conservative. The truth is that resort to the nuclear option, breaking the rules, making up new rules convenient to the leadership, is a radical, unprecedented action with consequences that no one can predict. Because once the rules are broken and rules are made up as one goes along, seeds of anarchy, of chaos, are sown. An atmosphere of anything goes is created, and the end justifies the means. We have already seen this in the actions of House Majority Leader Tom DeLay. We have an honored tradition that congressional redistricting occurs every 10 years after the decennial census, but the majority leader in the House wanted to increase his majority in the House. So what did he do? He tore up the rules and made up new rules, Tom DeLay's rules. But the real Tom DeLay rule is this: Anything goes. The end justifies the means. Situational ethics. I fear we are about to adopt that Tom DeLay rule in the Senate. This is profoundly bad news for this institution. I am also concerned about the message it sends to businesspeople, to husbands and wives, to our people. The message is if our national leaders can break the rules as a matter of convenience, if they can write their own rules, impose them on others, then maybe it is okay for everyone else to behave just like that. This is a deeply disturbing prospect. I implore the distinguished majority leader, Senator Frist, to consider the law of unintended consequences. He is threatening to break rule XXII in order to pass 100 percent of the President's judicial nominees. Once the rule is destroyed, and once the majority leader imposes a new rule to his liking, then who is to say where it will lead? It will be like an out- of-control virus. If 51 Senators can change any rule at any time for any reason, then anything is possible. The metaphor Senators are using is a ``nuclear option,'' and I would say that is true, it is nuclear because it does blow up this place. But there may be another metaphor, too: that the majority leader is letting the genie out of the bottle and there will be no putting that genie back once it is out. It will wreak destruction in ways no one now can predict or foresee. For example, once the Chair can make a determination about the rules and have that ruling upheld by 51 votes of the Senate, what is to say of the time-honored tradition we have in the Senate of a Senator being able to have the right of the floor and being able to speak for as long as he or she wants? That has been our right since the founding of the Senate. Once a Senator is recognized, that Senator can speak until they drop. I think the record is 24 or 25 hours, by former Senator Strom Thurmond. Who is to say if, in the future, someone gets up to speak but people want to move on and do something, that after that person speaks for 5 or 10 hours the majority leader would be recognized and make a point of order that the person is speaking unconstitutionally? They have the 51 votes to uphold the motion and that is the end of it. So a Senator's right to have the floor is subject to whatever the Chair wants. We may get it; we may not. We may not be able to speak for an hour or 2 hours or whatever we want. The Chair may say to the Senator from Iowa, You can speak for 3 minutes and then you have to sit down. They do that in the House of Representatives. They have a 5-minute rule. I know, I served there. But that is not the Senate. I am just saying who knows what might happen. It is possible. If we go down this road that is the precedent that is set. I do not know why the majority leader is doing this. Possibly what we are seeing here is an attempt to seize absolute power and unchecked control of all three branches of Government. The Republicans already control the executive branch. A majority of Supreme Court Justices are Republican nominees. So are the majority of judges on our Courts of Appeal, the circuit courts. Indeed, there is a Republican majority on 10 of the 12 circuits. Republicans have an iron grip on the House of Representatives. They have a 55-seat majority here in the Senate. Only one barrier now stands in the way of the Republican Party seizing absolute control of every aspect of our Government, all three branches, and that is the right of the minority in the Senate to filibuster. By unleashing the nuclear option, the Republican leadership would crush this last remaining check on its power. The filibuster is a more than 200-year-old tradition in the Senate; it has withstood the test of time. I do not believe the nuclear option reflects the desires or values of the American people. Americans are extremely wary of one-party dominance and control. This is a prime reason why so many voters split their ballots In the election last November. Republicans won the White House with less than 51 percent of the popular vote. The Republicans have a 52-percent majority in the House. They have a 55-percent majority here in the Senate. But they want to seize 100-percent control of the Government, including the third branch, the judicial branch. It is not healthy for our country. It is not healthy for our democracy. I do not believe for 1 minute this power grab reflects the wishes of the American people. When it comes to government, there are certain values and principles that the vast majority of Americans share. We prize our system of checks and balances. We respect minority rights and dissent. We want to ensure that minorities are protected. We understand the danger of majorities acting without check or restraint, running roughshod over those who would disagree. As a well-known minister once said: Democracy exists not just when the majority rules, but when the minority is absolutely safe. The rules of the Senate and the rule of extended debate give the minority that absolute safety. You take that away and you take away the minority rights in the Senate. Most Americans understand that checks and balances are the key to preserving our liberty. James Madison wrote: The accumulation of all powers, legislative, executive and judiciary, in the same hands may justly be pronounced the very definition of tyranny. But that is exactly the goal of the Republican leadership today. They seek the accumulation of all power--legislative, executive, and judiciary--in the same hands, their hands. This is profoundly dangerous. By resorting to the nuclear option, the majority would break the rules in order to change the rules. Under the rules of the Senate, it takes 67 votes to change the rules, 60 votes to end debate on a judicial nominee. But by resorting to this parliamentary gimmick, this nuclear option, the majority would change this rule with only 51 votes. The result would be to destroy any check or restraining influence on the power of the majority. This is not the American way. It is certainly not the wishes of the American people. In debate in the Constitutional Convention in Philadelphia, James Madison said the Senate would have two roles: first, to protect the people against their rulers, secondly, to protect the people against the transient impressions into which they themselves might be led. By attacking the filibuster, the Republican leaders would destroy the ability of the Senate to ``protect the people against their rulers.'' The Senate would lose its capacity to stand up to an out-of-control majority. Instead, the Senate would be turned into a rubberstamp for the majority's agenda, just as the House is a rubberstamp for the majority's agenda right now. That would be a betrayal of the Senate's traditional role as envisioned by the Founding Fathers. The Constitution gave Senators 6-year terms so they would not bend to the political passions of the moment. I remind my colleagues of the famous exchange between Thomas Jefferson and George Washington. On his return from France, Jefferson asked Washington at the breakfast table why he favored the creation of a second Chamber, the Senate. Washington replied with the question, ``Why did you pour that coffee into your saucer?'' Jefferson said, ``To cool it.'' To which Washington reportedly said: ``Even so we pour legislation into the senatorial saucer to cool it.'' For two centuries that is exactly how the Senate has worked. Because of the tradition of free speech and minority rights, specifically because of the threat of filibuster, Senators have a strong incentive to act with moderation and restraint, to make compromises, to accommodate the legitimate concerns of the minority. That is exactly what the nuclear option would demolish. The majority party in the Senate, whether Democratic or Republican, has always been frustrated by the minority's use of the filibuster. But I submit that frustration is the necessary byproduct of an effective system of checks and balances. It is the price we pay to safeguard minority rights. For decades, a determined conservative minority used the filibuster to block civil rights legislation and deny an up-or-down vote to a liberal Supreme Court nominee, Abe Fortas. Progressives were extremely frustrated by this exercise of minority rights and minority power. Now it is the Republicans' turn to be frustrated by the filibuster. They are frustrated because they can't get their way on judges 100 percent of the time. They have gotten their way on 95 percent of judicial nominees, but not 100 percent, and they believe this justifies breaking the rules, to get rid of the filibuster. I submit the Republicans' very frustration is evidence that the system of checks and balances here in the Senate is healthy and working, working exactly as it should. In 1995, I proposed to modify rule XXII in a way that would have given the minority an incentive to limit the use of the filibuster. It would not have taken it away. However, my proposal bore no resemblance to the nuclear option. First, I did not propose to break the Senate rules. I played strictly by the rules. I pursued my rule change through normal Senate procedures as a floor amendment. It would have taken the requisite 67 votes to pass on the floor, which is entirely appropriate when changing a time-honored Senate rule. By contrast, this nuclear option discards the rules. It would impose the Republicans' radical change with only 51 votes. Ten years ago I proposed to modify the filibuster rule as a matter of principle. Today the Republican leadership wants to modify the filibuster as a matter of political expedience, to make it possible to stack the courts with radical judges. They are pursuing unchecked power, the absolute control of all three branches of Government. In this context, the filibuster takes on even new importance. It is all that remains to check the majority's quest for absolute power. By the way, I might note parenthetically that 24 current Republican Senators actually voted against my proposed change to the filibuster back in 1995. The distinguished majority leader, Mr. Frist, was one of those Republicans opposing any change to the filibuster. Indeed, as has been noted time and time again, the majority leader voted in the year 2000, 5 years ago, to sustain a filibuster of a Clinton nominee, as did many other Republicans. Those same Republicans, who now say President Bush's judicial nominees have a constitutional right to an up-or-down vote on the Senate floor, denied that alleged right to scores and scores of President Clinton's judicial nominees, including, as I said earlier, a distinguished Iowan, Bonnie Campbell. Ms. Campbell, a former Iowa attorney general, respected Justice Department official, was nominated for the Eighth U.S. Circuit Court, but her nomination was blocked in committee. Let's be clear. If the issue is denying nominees an up-or-down vote by the full Senate, there is no practical difference whatsoever between blocking a nominee in committee or by filibuster on the floor. During the Clinton years, Republicans blocked judicial nominees again and again and again. They did it in committee, they did it by blue slip, or they blocked them on the floor. It didn't matter. But the nominees were denied an up-or-down vote on the floor of the Senate. The nuclear option is a flagrant abuse of power. The minority party, the Democrats, will resist it vigorously within the rules of the Senate. We have a responsibility, an oath of office to defend our constitutional system of checks and balances. We have a responsibility to defend the Senate's unique function as the last bastion of minority rights, as the last check on an abusive, out-of-control majority. But this should not be just the responsibility of the minority party. It should be the responsibility of all Senators who respect the rules and traditions of this body. It should be the duty of all Senators who value our democratic principles, our system of checks and balances, protection of minority rights. The very nature of the Senate as an institution is at stake. More than that, the very nature of how we operate as a government is at stake. As I said, when you destroy the rules by not following the rules, you invite chaos. Chaos invites tyranny. This is the time to look beyond party, to look beyond short-term partisan advantage. I have every hope there will be enough Senators, Democrats and Republicans alike, to disarm this destructive nuclear option. I have every hope that a critical mass of Senators will be true to the rules and traditions of this body and that we will act to preserve the integrity and independence of this great institution. I yield the floor.

Mr. HARKIN

Mr. HARKIN. Mr. President, for more than a decade, I have spoken out about the need to fundamentally reorient our approach to health care in America--to reorient it towards prevention, wellness and self care. I don't think you'll find too many people who would argue with the statement that if you get sick, the best place in the world to get the care you need is here in America. We have the best trained, highest- skilled health professionals in the world. We have cutting-edge, state- of-the-art equipment and technology. We have world-class health care facilities and research institutions. But, when it comes to helping people stay healthy and stay out of the hospital, we fall woefully short. In the U.S., we spend in excess of $1.8 trillion a year on health care. Fully 75 percent of that total is accounted for by chronic diseases--things like heart disease, cancer, and diabetes. And what these diseases have in common is that--in so many cases--they are preventable. In the United States, we fail to make an up-front investment in prevention. So we end up spending hundreds of billions on hospitalization, treatment, and disability. This is foolish--and, clearly, it is unsustainable. In fact, I've long said that we don't have a health care system here in America, we have a ``sick care'' system. And it is costing us dearly both in terms of health care costs and premature deaths. Consider the cost of major chronic diseases--diseases that, as I said, are so often preventable. For starters the annual cost of obesity is $117 billion. For cardiovascular disease is about $352 billion. For diabetes it's $132 billion. For smoking it's more than $75 billion. And for mental illness it's $150 billion; indeed, major depression is the leading cause of disability in the United States. Now, if I bought a new car, drove that car off the lot, and never maintained it--never checked the oil, never checked the transmission fluid, never got it tuned up--you'd think I was crazy, not to mention grossly irresponsible. The common-sense principle with an automobile is: ``I pay a little now to keep the car maintained, or I pay a whole lot later.'' Well, it's the same with our national health priorities. Right now, our health care system is in a downward spiral. We are not paying a little now; so we are paying a whole lot later. For example, we are failing to address the nation's growing obesity epidemic. Today 65 percent of our population is overweight or obese. Obesity is associated with numerous health problems and increased risks of diabetes, heart disease, stroke, and several types of cancer, to name just a few. Another contributing factor to our health crisis is tobacco. We don't hear as much about the dangers of tobacco use, today, as we used to. That's because there is a perception that we've turned the corner--that we've done all that we need to do. But that perception is not accurate. In 2002, 46 million American adults regularly smoked cigarettes--that 26 percent of our population. Nearly 40 percent of college-aged students smoke. What this means is that after decades of education and efforts to stop tobacco use, more than one in every four Americans is still addicted to nicotine and smoking. Mental health is another enormous challenge that we are grossly neglecting. Mental health and chronic disease are intertwined. They can trigger one another. It is about time we stop separating the mind and body when discussing health. Prevention and mental health promotion programs should be integrated into our schools, workplaces, and communities along with physical health screenings and education. Surely, at the outset of the 21st century, it's time to move beyond the lingering shame and stigma that often attend mental health. Seventy percent of all deaths in the U.S. are now linked to chronic conditions such as heart disease, cancer, and diabetes. In so many cases, these chronic diseases are caused by poor nutrition, physical inactivity, tobacco use, and untreated mental illness. This is unacceptable. After many months of meetings and discussions with Iowans and experts across the nation, today I am re-introducing comprehensive legislation designed to transform America's ``sick care'' system into a true health care system--one that emphasizes prevention and health promotion. I am calling this bill the HeLP America Act, with HeLP as an acronym for Healthy Lifestyles and Prevention. The aim is to give individuals and communities the information and tools they need to take charge of their own health. Because if we are serious about getting control of health-care costs and health-insurance premiums, then we must give people access to preventive care . . . and we must give people the tools they need to stay healthy and stay out of the hospital. This will take a sustained commitment from government, schools, communities, employers, health officials, and the tobacco and food industries. But a sustained effort can have a huge payoff--for individuals and families, for employers, for society, for government budgets, and for the economy at large. As I said, the HeLP America Act is comprehensive legislation. It a very complex, multifaceted bill. But, this afternoon, I'd just like to outline the bill's major elements: The first component addresses healthy kids and schools. Prevention and the development of a healthy habits and lifestyles must begin in the early years, with our children. Unfortunately, today, we are heading in exactly the wrong direction. More and more children all across America are suffering from poor nutrition, physical inactivity, mental health issues, and tobacco use. For example, just since the 1980s, the rates of obesity have doubled in children and tripled in teens. Even more alarming is the fact that a growing number of children are experiencing what used to be thought of primarily as adult health problems. Almost two-thirds--60 percent--of overweight children have at least one cardiovascular disease risk factor. Recent studies of children have shown that increasing weight, greater salt consumption from fast food, and poor eating habits have contributed to the rise in blood pressure, higher cholesterol levels, and a shockingly rapid increase in adult-onset diabetes. The HeLP America Act will more than double funding for the successful PEP program, which promotes health and physical education programs in our public schools. I find it disturbing that more than one third of youngsters in grades 9 through 12 do not regularly engage in adequate physical activity. This is a shame, because studies show that regular physical activity boosts self-esteem and improves health. The HeLP America Act will also expand the Harkin Fruit and Vegetable Program to provide more free fresh fruits and vegetables in more public schools. The bill will also encourage give schools incentives to create healthier environments, including goals for nutrition education and physical activity. The HeLP America Act would also establish a grant program to provide mental health screenings and prevention programs in schools, along with training for school staff to help them recognize children exhibiting early warning signs. It will improve access to mental health services for students and their families. New to the HeLP Act this year is a strong focus on breastfeeding promotion. Sound nutrition begins the moment a baby is born and there is a vast body of scientific evidence that shows beyond a shadow of a doubt that mom's milk is the ideal form of nutrition to promote child health. But in the U.S. we don't do enough to encourage breastfeeding. The HeLP America Act seeks to remove some of those barriers and to encourage new mothers to breastfeed. The second broad component of the HeLP American Act addresses Healthy Communities and Workplaces. For example, the bill aims to create a healthier workforce by providing tax credits to businesses that offer wellness programs and health club memberships. Studies show that, on average, every $1.00 that is invested in workplace wellness returns $3.00 in savings on health costs, absences from work, and so on. At a field hearing in Iowa last year, I heard from Mr. Lynn Olson, CEO of Ottumwa Regional Health Center. The Center offers a comprehensive wellness program for its employees, including reduced health insurance premiums for those employees who meet individual health goals. The Center has seen tremendous savings from their investment in health promotion. My bill also creates a grant program for communities, encouraging them to develop localized plans to promote healthier lifestyles. For example, we want to support efforts like those going on in Webster County and Mason City, IA, where mall walking programs have been expanded into community-wide initiatives to promote wellness. At the same time, the bill provides new incentives for the construction of bike paths and sidewalks to encourage more physical activity, especially walking. It is shocking that, today, roughly one- quarter of walking trips take place on roads without sidewalks or shoulders. And bike lanes are available for only about 5 percent of bike trips. As my colleagues know, I have been a longstanding advocate for the rights of people with disabilities. So I have given special attention to health-promotion programs and activities that include this population. I just mentioned the bill's incentives to create bike lanes and sidewalks on newly constructed roads. This will make a big difference to people with disabilities, who often are forced to travel in the street alongside cars because there are no sidewalks or bike lanes available for wheelchairs. The Centers for Disease Control has funded a program called Living Well with a Disability, which has actually decreased secondary conditions and led to improved health for participants. The program is an eight-session workshop that teaches individuals with disabilities how to change their nutrition and level of physical activity. The program not only increases healthy activities for people with disabilities, but has also led to a 10 percent decline in the cost for medical services, particularly emergency-room care and hospital stays. In addition, my bill includes a Working Well with a Disability program, which will build partnerships between employers and vocational rehabilitation offices with the aim of developing wellness programs in the workplace. Mr. President, the third component of the HeLP America Act addresses Responsible Marketing and Consumer Awareness. Having accurate, readily available information about the nutritional value of the foods we eat is the first step toward improving overall nutrition. Unfortunately, because of all the gimmicks and hype that marketers use to entice us to buy their products, determining the nutritional value of the foods we buy can be problematic--especially in restaurants. This is why the HeLP America bill proposes to extend the nutritional labeling requirements of the National Labeling and Education Act, which currently covers the vast majority of retail foods, to restaurants foods as well, which were exempted from the NLEA when it first passed. The marketing of junk food--especially to kids--is out of control. It was estimated that junk food marketers, alone, spent $15 billion in 2002 promoting their fare. And, I don't have to tell you, they are not advertising broccoli and apples. No, the majority of these ads are for candy and fast food--foods that are high in sugar, salt, fat, and calories. Children--especially those under 8 years of age--do not always have the ability to distinguish fact from fiction. The number of TV ads that kids see over the course of their childhood has doubled from 20,000 to 40,000. The sad thing is that, way back in the 1970s, the Federal Trade Commission recommended banning TV advertising to kids. And what was Congress's response? We made it even harder for the FTC to regulate advertising for children than it is to regulate advertising for adults. My bill will restore the authority of the FTC to regulate marketing to kids, and it encourages the FTC to do so. The fourth component of the HeLP American Act addresses Reimbursements for Prevention Services. Right now, our medical system is setup to pay doctors to perform a $20,000 gastric bypass instead of offering advice on how to avoid such risky procedures. The bill will reimburse and reward physicians for practicing prevention and screenings. It will also expand Medicare coverage to pay for counseling for nutrition and physical activity, mental health screenings, and smoking-cessation programs. It also would establish a demonstration project in the Medicare program, long overdue in my opinion, under which we can learn how best to use our health care dollars to prevent chronic diseases rather than just manage them once they've occurred. Frankly, it's a little embarrassing that we haven't done this before. Finally, let me point out that the HeLP America Act will be paid for by creating a new National Health Promotion Trust Fund paid for through penalties on tobacco companies that fail to cut smoking rates among children, by ending the taxpayer subsidy of tobacco advertising, and also by reinstating the top income tax rates for wealthy Americans. It's time for the Senate to lead America in a new direction. We need a new health care paradigm--a prevention paradigm. Some will argue that avoiding obesity and preventable disease is strictly a matter of personal responsibility. Well, we all agree that individuals should act responsibly. I'm all for personal responsibility. But I also believe in government responsibility. Government has a responsibility to ensure that people have the information and tools and incentives they need to take charge of their health. And that is what the HeLP America Act is all about. Of course, this description of my bill just scratches the surface. The HeLP America Act is comprehensive. It is ambitious. And I fully expect an uphill fight in some quarters of Congress. But just as with the Americans with Disabilities Act 14 years ago, I am committed to doing whatever it takes--and for as long as it takes-- to pass this critically needed legislation. It's time to heed the Golden Rule of Holes, which says: When you are in a hole, stop digging. Well, we have dug one whopper of a hole by failing to emphasize prevention and wellness. And it's time to stop digging.

Mr. HARKIN

Mr. HARKIN. Mr. President, for more than a decade, I have spoken out about the need to fundamentally reorient our approach to health care in America--to reorient it towards prevention, wellness and self care. I don't think you'll find too many people who would argue with the statement that if you get sick, the best place in the world to get the care you need is here in America. We have the best trained, highest- skilled health professionals in the world. We have cutting-edge, state- of-the-art equipment and technology. We have world-class health care facilities and research institutions. But, when it comes to helping people stay healthy and stay out of the hospital, we fall woefully short. In the U.S., we spend in excess of $1.8 trillion a year on health care. Fully 75 percent of that total is accounted for by chronic diseases--things like heart disease, cancer, and diabetes. And what these diseases have in common is that--in so many cases--they are preventable. In the United States, we fail to make an up-front investment in prevention. So we end up spending hundreds of billions on hospitalization, treatment, and disability. This is foolish--and, clearly, it is unsustainable. In fact, I've long said that we don't have a health care system here in America, we have a ``sick care'' system. And it is costing us dearly both in terms of health care costs and premature deaths. Consider the cost of major chronic diseases--diseases that, as I said, are so often preventable. For starters the annual cost of obesity is $117 billion. For cardiovascular disease is about $352 billion. For diabetes it's $132 billion. For smoking it's more than $75 billion. And for mental illness it's $150 billion; indeed, major depression is the leading cause of disability in the United States. Now, if I bought a new car, drove that car off the lot, and never maintained it--never checked the oil, never checked the transmission fluid, never got it tuned up--you'd think I was crazy, not to mention grossly irresponsible. The common-sense principle with an automobile is: ``I pay a little now to keep the car maintained, or I pay a whole lot later.'' Well, it's the same with our national health priorities. Right now, our health care system is in a downward spiral. We are not paying a little now; so we are paying a whole lot later. For example, we are failing to address the nation's growing obesity epidemic. Today 65 percent of our population is overweight or obese. Obesity is associated with numerous health problems and increased risks of diabetes, heart disease, stroke, and several types of cancer, to name just a few. Another contributing factor to our health crisis is tobacco. We don't hear as much about the dangers of tobacco use, today, as we used to. That's because there is a perception that we've turned the corner--that we've done all that we need to do. But that perception is not accurate. In 2002, 46 million American adults regularly smoked cigarettes--that 26 percent of our population. Nearly 40 percent of college-aged students smoke. What this means is that after decades of education and efforts to stop tobacco use, more than one in every four Americans is still addicted to nicotine and smoking. Mental health is another enormous challenge that we are grossly neglecting. Mental health and chronic disease are intertwined. They can trigger one another. It is about time we stop separating the mind and body when discussing health. Prevention and mental health promotion programs should be integrated into our schools, workplaces, and communities along with physical health screenings and education. Surely, at the outset of the 21st century, it's time to move beyond the lingering shame and stigma that often attend mental health. Seventy percent of all deaths in the U.S. are now linked to chronic conditions such as heart disease, cancer, and diabetes. In so many cases, these chronic diseases are caused by poor nutrition, physical inactivity, tobacco use, and untreated mental illness. This is unacceptable. After many months of meetings and discussions with Iowans and experts across the nation, today I am re-introducing comprehensive legislation designed to transform America's ``sick care'' system into a true health care system--one that emphasizes prevention and health promotion. I am calling this bill the HeLP America Act, with HeLP as an acronym for Healthy Lifestyles and Prevention. The aim is to give individuals and communities the information and tools they need to take charge of their own health. Because if we are serious about getting control of health-care costs and health-insurance premiums, then we must give people access to preventive care . . . and we must give people the tools they need to stay healthy and stay out of the hospital. This will take a sustained commitment from government, schools, communities, employers, health officials, and the tobacco and food industries. But a sustained effort can have a huge payoff--for individuals and families, for employers, for society, for government budgets, and for the economy at large. As I said, the HeLP America Act is comprehensive legislation. It a very complex, multifaceted bill. But, this afternoon, I'd just like to outline the bill's major elements: The first component addresses healthy kids and schools. Prevention and the development of a healthy habits and lifestyles must begin in the early years, with our children. Unfortunately, today, we are heading in exactly the wrong direction. More and more children all across America are suffering from poor nutrition, physical inactivity, mental health issues, and tobacco use. For example, just since the 1980s, the rates of obesity have doubled in children and tripled in teens. Even more alarming is the fact that a growing number of children are experiencing what used to be thought of primarily as adult health problems. Almost two-thirds--60 percent--of overweight children have at least one cardiovascular disease risk factor. Recent studies of children have shown that increasing weight, greater salt consumption from fast food, and poor eating habits have contributed to the rise in blood pressure, higher cholesterol levels, and a shockingly rapid increase in adult-onset diabetes. The HeLP America Act will more than double funding for the successful PEP program, which promotes health and physical education programs in our public schools. I find it disturbing that more than one third of youngsters in grades 9 through 12 do not regularly engage in adequate physical activity. This is a shame, because studies show that regular physical activity boosts self-esteem and improves health. The HeLP America Act will also expand the Harkin Fruit and Vegetable Program to provide more free fresh fruits and vegetables in more public schools. The bill will also encourage give schools incentives to create healthier environments, including goals for nutrition education and physical activity. The HeLP America Act would also establish a grant program to provide mental health screenings and prevention programs in schools, along with training for school staff to help them recognize children exhibiting early warning signs. It will improve access to mental health services for students and their families. New to the HeLP Act this year is a strong focus on breastfeeding promotion. Sound nutrition begins the moment a baby is born and there is a vast body of scientific evidence that shows beyond a shadow of a doubt that mom's milk is the ideal form of nutrition to promote child health. But in the U.S. we don't do enough to encourage breastfeeding. The HeLP America Act seeks to remove some of those barriers and to encourage new mothers to breastfeed. The second broad component of the HeLP American Act addresses Healthy Communities and Workplaces. For example, the bill aims to create a healthier workforce by providing tax credits to businesses that offer wellness programs and health club memberships. Studies show that, on average, every $1.00 that is invested in workplace wellness returns $3.00 in savings on health costs, absences from work, and so on. At a field hearing in Iowa last year, I heard from Mr. Lynn Olson, CEO of Ottumwa Regional Health Center. The Center offers a comprehensive wellness program for its employees, including reduced health insurance premiums for those employees who meet individual health goals. The Center has seen tremendous savings from their investment in health promotion. My bill also creates a grant program for communities, encouraging them to develop localized plans to promote healthier lifestyles. For example, we want to support efforts like those going on in Webster County and Mason City, IA, where mall walking programs have been expanded into community-wide initiatives to promote wellness. At the same time, the bill provides new incentives for the construction of bike paths and sidewalks to encourage more physical activity, especially walking. It is shocking that, today, roughly one- quarter of walking trips take place on roads without sidewalks or shoulders. And bike lanes are available for only about 5 percent of bike trips. As my colleagues know, I have been a longstanding advocate for the rights of people with disabilities. So I have given special attention to health-promotion programs and activities that include this population. I just mentioned the bill's incentives to create bike lanes and sidewalks on newly constructed roads. This will make a big difference to people with disabilities, who often are forced to travel in the street alongside cars because there are no sidewalks or bike lanes available for wheelchairs. The Centers for Disease Control has funded a program called Living Well with a Disability, which has actually decreased secondary conditions and led to improved health for participants. The program is an eight-session workshop that teaches individuals with disabilities how to change their nutrition and level of physical activity. The program not only increases healthy activities for people with disabilities, but has also led to a 10 percent decline in the cost for medical services, particularly emergency-room care and hospital stays. In addition, my bill includes a Working Well with a Disability program, which will build partnerships between employers and vocational rehabilitation offices with the aim of developing wellness programs in the workplace. Mr. President, the third component of the HeLP America Act addresses Responsible Marketing and Consumer Awareness. Having accurate, readily available information about the nutritional value of the foods we eat is the first step toward improving overall nutrition. Unfortunately, because of all the gimmicks and hype that marketers use to entice us to buy their products, determining the nutritional value of the foods we buy can be problematic--especially in restaurants. This is why the HeLP America bill proposes to extend the nutritional labeling requirements of the National Labeling and Education Act, which currently covers the vast majority of retail foods, to restaurants foods as well, which were exempted from the NLEA when it first passed. The marketing of junk food--especially to kids--is out of control. It was estimated that junk food marketers, alone, spent $15 billion in 2002 promoting their fare. And, I don't have to tell you, they are not advertising broccoli and apples. No, the majority of these ads are for candy and fast food--foods that are high in sugar, salt, fat, and calories. Children--especially those under 8 years of age--do not always have the ability to distinguish fact from fiction. The number of TV ads that kids see over the course of their childhood has doubled from 20,000 to 40,000. The sad thing is that, way back in the 1970s, the Federal Trade Commission recommended banning TV advertising to kids. And what was Congress's response? We made it even harder for the FTC to regulate advertising for children than it is to regulate advertising for adults. My bill will restore the authority of the FTC to regulate marketing to kids, and it encourages the FTC to do so. The fourth component of the HeLP American Act addresses Reimbursements for Prevention Services. Right now, our medical system is setup to pay doctors to perform a $20,000 gastric bypass instead of offering advice on how to avoid such risky procedures. The bill will reimburse and reward physicians for practicing prevention and screenings. It will also expand Medicare coverage to pay for counseling for nutrition and physical activity, mental health screenings, and smoking-cessation programs. It also would establish a demonstration project in the Medicare program, long overdue in my opinion, under which we can learn how best to use our health care dollars to prevent chronic diseases rather than just manage them once they've occurred. Frankly, it's a little embarrassing that we haven't done this before. Finally, let me point out that the HeLP America Act will be paid for by creating a new National Health Promotion Trust Fund paid for through penalties on tobacco companies that fail to cut smoking rates among children, by ending the taxpayer subsidy of tobacco advertising, and also by reinstating the top income tax rates for wealthy Americans. It's time for the Senate to lead America in a new direction. We need a new health care paradigm--a prevention paradigm. Some will argue that avoiding obesity and preventable disease is strictly a matter of personal responsibility. Well, we all agree that individuals should act responsibly. I'm all for personal responsibility. But I also believe in government responsibility. Government has a responsibility to ensure that people have the information and tools and incentives they need to take charge of their health. And that is what the HeLP America Act is all about. Of course, this description of my bill just scratches the surface. The HeLP America Act is comprehensive. It is ambitious. And I fully expect an uphill fight in some quarters of Congress. But just as with the Americans with Disabilities Act 14 years ago, I am committed to doing whatever it takes--and for as long as it takes-- to pass this critically needed legislation. It's time to heed the Golden Rule of Holes, which says: When you are in a hole, stop digging. Well, we have dug one whopper of a hole by failing to emphasize prevention and wellness. And it's time to stop digging.

Mr. HARKIN

Mr. HARKIN. Mr. President, I salute Joseph P. Fitzgerald, who is retiring after 33 years of dedicated service to the Government and people of the United States of America. For the past quarter century, Mr. Fitzgerald has worked in the Audiovisual Program Development Branch at the Lister Hill National Center for Biocommunications, which is part of the National Library of Medicine at the National Institutes of Health in Bethesda, MD. Mr. Fitzgerald, who is a renaissance man of creative vision and artistic talent, has made exceptional contributions to the outreach and communications mission of the largest biomedical library in the world. As technological advances in the dissemination of both visual and text- based information have evolved over the past 25 years, Mr. Fitzgerald has led the way in adopting computer-based graphics systems. And he has helped the National Library of Medicine to communicate the most current and reliable medical and consumer health information to medical professionals, researchers, patients, families and the public. The number 25 figures prominently in the life story of Joe Fitzgerald for another reason, too. He recently became the 25th person in the history of the Republic to execute a design for the front of a circulating coin. His groundbreaking portrait of Thomas Jefferson graces the new U.S. five-cent coin, as will his obverse design of the Lewis and Clark expedition, which will be released in August. Both commissions were awarded as part of the United States Mint at the Treasury Department's Artistic Infusion Program. Mr. Fitzgerald's portrait of Thomas Jefferson marks the first redesign of the front of the nickel in 67 years. His nickel designs have been acclaimed throughout the coin collecting community, and Mr. Fitzgerald has received significant national press attention. Joe Fitzgerald earned a B.A. in fine arts from the University of Maryland, College Park and pursued graduate studies in printmaking at the State University of New York at Oswego. He has served several Federal agencies: the United States Postal Service, summers, 168-1972; the Food & Drug Administration, 1972-1973; the Consumer Product Safety Commission, 1973-1980; and the National Library of Medicine, 1980-2005. Mr. Fitzgerald has earned numerous awards for outstanding contributions and service to the National Library of Medicine, including the 1996 NLM Director's Honor Award for exceptional contributions to the mission of the library through the creative application of his artistic talent, and the 2003 National Institutes of Health Award for Merit for his organization, coordination and congenial leadership in effectively orchestrating the ``Turning the Pages'' historical medical books program. In addition, Mr. Fitzgerald is a gifted fine artist. Nationally recognized for his work in paint, pastel and digital media, his creations have been sent around the world through the Embassy Art program, and are held in many private collections. He is currently represented by the Foxhall Gallery in Washington, DC. Joe Fitzgerald is one of the most beloved individuals ever to tread the NIH campus, and I wish him well in his retirement. He is married to Jean Hill Fitzgerald, another career civil servant who currently works at the National Archives. I thank Joe for distinguished career in public service, and I wish him many years of happiness in retirement.

Mr. HARKIN

Mr. HARKIN. Mr. President, this amendment is about doing what is logical regarding sidewalks and bike paths in the planning stages. You will hear there is money in this bill for sidewalks and bike trails. That is true. But more often than not, we are always doing things after the fact. We are redoing it. All this amendment says is in the planning upfront, you plan for sidewalks where they are logical. You plan for bike paths where they are logical. You plan it in the beginning, not doing it later on. These are some of the organizations who support the amendment: the American Association of Retired People, the Association of Metropolitan Planning Organizations--they are the ones who have to do the planning; they are in favor of this amendment--American Bikes, Paralyzed Veterans of America--people with disabilities need more sidewalks--the American Heart Association, and the American Public Health Association.

Mr. HARKIN. Mr. President, I ask for the yeas and nays.

Mr. HARKIN. Wait just a second, Mr. President. The Senator said he wants to do what at 5:30?

Mr. HARKIN. Mr. President, I wanted to make sure the Senator from Missouri had adequate time to speak. I think I have made my case. I wanted to point out who is in support of this amendment. I have a nice chart that says it all. The American Association of Retired People, the Association of Metropolitan Planning Organizations, the MPOs, are in favor of this, as well as America Bikes, Natural Resources Defense Council; Paralyzed Veterans of America, again, because of the disability issue; America Walks; the American Heart Association strongly supports this; the American Public Health Association; the American Society of Landscape Architects; the American Planning Association, among a lot of others, are in favor of this amendment. I hope we can adopt this amendment for a number of reasons, not the least of which is for the health and welfare of the American people and to get more people walking and biking but to get it done upfront, so when they are planning, it is integrated upfront, and that is really what this amendment does, in essence. This amendment asks for upfront planning, that they have a policy statement, that metropolitan planning organizations have a complete streets policy, that all of this is done upfront. Let us quit coming in and backfilling and putting in bike paths and sidewalks after the fact. Let us get it done upfront. That is really what this is all about. I ask unanimous consent that letters from the following national organizations be printed in the Record: the Surface Transportation Policy Project, AARP, America Walks, the National Center for Bicycling and Walking, the Metropolitan Planning Organizations, the League of American Bicyclists, The American Society of Landscape Architects and the National Resources Defense Council, and a fact sheet from the National Association of County & City Health Officials.

Mr. HARKIN. This amendment will improve our transportation system. It will improve pedestrian and bicycle safety. And it will be good for the health and wellness of the American people. I urge my colleagues to join me in a strong, bipartisan vote in favor of this amendment. I yield the floor.

Mr. HARKIN. Mr. President, reserving the right to object, I wonder if the Chairman would permit me to modify my amendment by striking lines 6 through line 16 on page 5 dealing with research.

Mr. HARKIN. I ask unanimous consent to do that.

Mr. HARKIN. Well, I had a request from Senator Carper who wanted to speak. I assume Senator Bond may want to speak. I do not know. That is only 7 more minutes.

Mr. HARKIN. Absolutely.

Mr. HARKIN. Mr. President, the amendment I am offering, on behalf of Senators Kennedy, Obama, Carper, and myself, calls for several simple adjustments to current practices at the Federal, State, and local level. The costs are minor, but the impact on safety for those who walk and ride bikes would be large. With the safety improvements that could result from this amendment, I believe we could increase pedestrian and bike traffic, and we could increase exercise to the benefit of American's health. We can reduce traffic congestion, and we can provide for safer travel for those who want to walk or ride a bike. At the outset, I want to acknowledge that there are funds in the bill for increased bike paths and trails. We have kept the enhancement money. That is all well and good. I don't know the exact amount of money, but there is a quite a bit involved. The problem is there is nothing in current practice that requires State departments of transportation or metropolitan planning organizations to integrate in their planning upfront for bike paths and sidewalks when they are planning highways. Again, I think a lot of the good money for bike paths and trails will be used to redo and retrofit what they should have done in the first place. That is what we always seem to be doing-- we'll fix it up and add something later on. That always costs more money. What this amendment does is it says: Let's have them at the initial planning stage integrate into their planning sidewalks and bike paths. The fact is, our current transportation system has been engineered in a way that is, in many cases, unfriendly and often very dangerous to nonmotorized travel. Again, my amendment promotes Federal, State, and local actions to make walking and biking safer and to increase the total number of walking and bicycling trips. Specifically, the amendment requires each State to adopt a ``complete streets'' policy to accommodate bicyclists and pedestrians by ensuring that all users are considered when communities are built or modernized. While studies show that Americans would like to bike and walk more, many roads do not have sidewalks or bike paths, making them dangerous for pedestrians and bike riders. In many cases, traffic lights do not allow enough time for the elderly or people with disabilities or children to safely cross busy intersections. Meanwhile, we are constructing new housing developments without sidewalks. Go out and take a look at some of the new housing developments being added in any State. A lot of times there is not even a sidewalk. How can you ask kids to walk to school if they don't have a sidewalk? My wife and I get up every morning. We have a mile route that we walk. We have sidewalks for part of the way, and there aren't any sidewalks for the rest of the way. Again, it is about getting this integrated in the initial planning. While studies show that Americans would like to bike and walk more, many roads don't have sidewalks or bike paths. It is dangerous for pedestrians. We are building roads without bike lanes. Quite frankly, we are heading in the wrong direction. Quite frankly, to promote more healthy living, we must promote people walking or biking more. I will have more to say about that in a minute. Experts I talk to tell me that even a modest increase in pedestrian and bike traffic will get some cars off the road. That can have a significant positive impact on traffic congestion and gridlock. Research shows that often a surprisingly small increase in the number of cars can make the difference between a smooth flow of vehicles and a time-wasting traffic jam. According to the U.S. Department of Transportation, the number of trips that are taken that are 1 mile or less is about one out of four. In other words, about 25 percent of all trips taken are 1 mile or less. Nearly half of all the trips taken in this country are under 5 miles. So it wouldn't take a huge shift to have an effect on traffic congestion. The path to safer travel on foot or by bike is also the path to a smarter, healthier, more efficient vehicle transportation system. Each of the provisions in my amendment is intended to help us move forward toward safer travel for people in vehicles, pedestrians, for people who use bikes or people who use wheelchairs, or for people simply trying to cross a road safely in a neighborhood. When we debate the highway bill, we typically talk about the Nation's infrastructure deficit, about jobs and economic competitiveness, the movement of goods, and other broader transportation goals. But we neglect other matters that are of real concern to people all across America in terms of transportation. For example, what are we doing to improve the safety of pedestrians and bicyclists? In the Washington, DC, area we have recently experienced a rash of pedestrian fatalities. All across the country bicyclists put their lives at risk on roads that make no accommodation for nonmotorized traffic. No one denies that over the years we have built a transportation system that neglects and endangers nonmotorized travel. Again, this costs us dearly in terms of needless loss of life or permanent disabilities caused by accidents. It also has other consequences. When we give people no alternative to using their cars, they use their cars. So we add more and more vehicles to our roads and highways, 25 percent of which are used for trips of less than a mile. This translates into traffic delays, congestion, often gridlock. We simply must give more attention to the safety of pedestrians and those who use bicycles or who walk or who use wheelchairs. It is pretty shocking when we look at the statistics. Our Federal system for tracking fatalities, known as FARS, tells us that during the decade from 1994 to 2003, nearly 52,000 pedestrians were killed in traffic accidents in the United States. During the same 10-year period, more than 7,400 bicyclists were killed. Though the data is less reliable with regard to injuries, we know the number of nonfatal injuries ran into the hundreds of thousands during that same 10-year period. In 2003, the most recent year for which we have data, nearly 5,000 pedestrians and more than 600 bicyclists were killed in the U.S., again, with many more thousands injured. Fully 13 percent of all transportation fatalities are pedestrians and bicyclists--13 percent. That is a rate far in excess of the share of trips taken by pedestrians and bicyclists. The bottom line is it is disproportionately dangerous to be a pedestrian or bicyclist in the U.S. This is one big reason why people are opting not to walk or ride a bicycle. Instead, they are getting in their cars and they are contributing to traffic jams. Again, about 25 percent are going less than a mile, and over half of the time they are going less than 5 miles. The journey to work data in the 2000 census tells a dismal story. Compared to 1990, despite a big increase in population, the number of people who walked to work fell by almost three-quarters of a million-- 727,000, to be exact. In 1990, 3.9 percent of Americans walked to work. Ten years later, in 2000, that had fallen to 2.9 percent--a 25-percent decline in the number of Americans who walk to work, in a 10-year period of time. These various statistics tell us that many fatalities and injuries to pedestrians and bicyclists are preventable if we make the safety of nonmotorized travel a higher priority, and that is exactly what my amendment is intended to do, to put it into the planning stage and make it a higher priority. This amendment, I guess you could say, is also designed to significantly reduce the number of car trips taken. As I said, consider that trips of a mile or less represent the highest share of all car trips we make every day--a quarter of all of those trips. This means there is a huge, untapped potential to shift a significant portion of these short-distance trips to foot or bicycle, if we make some modest adjustments and if we step up our focus on safety. A 2003 transportation research board study showed that residents of neighborhoods with sidewalks were 65 percent more likely to walk than residents of neighborhoods without sidewalks. That kind of makes sense. As I said, my wife and I take a mile walk in the morning, and we have sidewalks part of the way, and part of the way we are out in the street. Fortunately, there is not a lot of traffic at that time. More than once, we have been walking down the street where there are no sidewalks and you don't hear a car coming and they slip by you. I have often thought what if I happen to step one way or the other while walking and do not hear that car coming. That is why people don't walk more. A study in Toronto documented a 23-percent increase in bicycle traffic after the installation of a bicycle lane. Think about that. They put in a bicycle lane and there was a 23-percent increase in bicycle traffic because people are more safe. They can travel on a bicycle and know they are not going to get hit. As a Senator who is a chief sponsor of the Americans with Disabilities Act, which we passed 15 years ago, I can testify that stepped-up attention to pedestrian improvement and access will be enormously beneficial to people with disabilities and also to our growing population of seniors. Right now, about 85 percent of bus and rail users get to the bus stops and subway stations on foot. Many are people with disabilities. And seniors have no choice but to rely on costly paratransit services; they cost a lot of money. A lot of times we pay for it out of taxpayer dollars. We can reduce those costs by building new walkways and improving the existing walkways. I have something here that was put out by the National Association of County and City Health Officials called Public Health and Land Use Planning and Community Design. It says here that a Texas study--that is the State I referred to earlier--found that for three out of five disabled and elderly people, there are no sidewalks between their homes and the closest bus stop. I will repeat that. A Texas study found that for three out of five disabled and elderly people, there are no sidewalks between their homes and the closest bus stop. One of the reasons we passed the Americans with Disabilities Act was so more people with disabilities would get into the workforce. More often than not, they rely on a bus to get there. How are they going to get to the bus stop if they don't have a sidewalk on which to even get to the bus stop? Over 55 percent of all pedestrian deaths occur in neighborhoods that are often designed with no sidewalks or otherwise inadequate pedestrian accommodations. So, again, in terms of helping people with disabilities make sure they can get to a job, or get to shopping, or whatever they need to do, they rely upon transit services, buses. But if they cannot even get to the bus stop, what good is it? Over the last two generations, we have seen dramatic changes in how children go to school. As recently as 30 years ago, up to 70 percent of children were walking or riding bikes to school. Outside of every school you would see bicycle racks loaded with dozens of bikes. Not anymore. Today, nearly 90 percent of our kids are traveling to school in vehicles, mostly buses. But if you checked the high school parking lots, you know it is cars, too. In addition, a growing number of parents are driving their kids to school, putting further stress on the roadways during the morning rush hour. Again, the logical alternative is to provide safe, convenient options to encourage children to walk or bike to school. I was saying earlier to Senators on the floor, I remember my own two daughters, when they went to public school out in Virginia. We live about a mile from school. Well, there was a sidewalk about a third of the way, and about two-thirds of the way there was no sidewalk. It was a busy thoroughfare. How are you going to let them bike? You are not going to let them walk. So they got a car to drive a mile. I would not let our kids walk on that street and neither would our neighbors. Again, they will come along later and retrofit a sidewalk and that will cost more money, or they will put in a bike path later. Why don't we do it up front, get the planning done up front? That is what this amendment is all about. Our focus in a transportation bill, I believe, should not strictly be on moving vehicles. We should be more broadly focused on moving people and making it possible for more people to move themselves by foot or by bicycle. For every American who opts to get to work, school, or the grocery store by foot or bicycle, that is less costs for road building and maintenance, zero contribution to traffic congestion, zero costs in terms of pollution and environmental degradation. Every walking and bicycle trip that substitutes for a car trip, especially during rush hour, makes a big difference. In local situations, where we can encourage hundreds or thousands of people to shift to walking and bicycling, this can have a dramatically positive impact on the transportation system. So improving and expanding sidewalks and bike paths is not only about safety, it is about maximizing the performance of our transportation systems. Again, the good news is, to make a positive difference, large numbers of vehicles do not need to be moved off a congested roadway. Just some of them need to be moved. It is the incremental user that spells the difference between free-flowing traffic and time-wasting congestion, and that is why any thoughtful, effective transportation policy for this Nation must aim for at least modest gains in walking and bicycling. So again I have talked about how, by investing in sidewalks and bike paths, we can reduce the stresses on our transportation system. I have also talked about how this can improve safety for pedestrians and bikers. There is one other huge benefit that, by itself, would justify passing this amendment. Simply put, by encouraging more Americans to spend more time walking and biking, we can have a major positive impact on their health and their wellness. We can reduce the incidence of obesity and chronic diseases. This, in turn, will lead to savings in health care costs, including Medicare and Medicaid. Ninety million people in the United States are living with chronic diseases, and many of these can be prevented through changes in lifestyle--for example, by eating nutritious foods and getting plenty of physical exercise. I wish to stress, physical exercise. When all is said and done, aside from tobacco use and genetic predisposition, there are essentially two things that lead to chronic disease: Poor nutrition and lack of physical activity. They also contribute to being overweight and obese. So we need to be doing everything possible to encourage Americans to engage in more walking and bicycling. We can begin by making it possible for more young people to walk or to bike to school. Currently, only 8 percent of elementary schools and 6 percent of high schools provide daily physical education year round for all students. More than one-third of youngsters in grades 9 to 12 do not engage regularly in vigorous physical activity. No wonder we have an epidemic of childhood obesity. No wonder that American adolescents rank as the most overweight in the industrialized world. And the picture is just as bleak for adults. Almost 40 percent of American adults are sedentary. In the United States, only six percent of trips are by walking or biking, compared to 49 percent of trips in Sweden and 54 percent of trips in Italy. Research shows that the amount of time people spend in their cars correlates more strongly with overweight and obesity than income, education, gender, or ethnicity. One remarkable study compared the health of people living in walking- and-biking-friendly cities with the health of people living in sprawling, car-dependent suburbs. The study, published in 2003 in the American Journal of Health Promotion, found that people living in counties marked by sprawling development are likely to walk less and weigh more than people who live in less sprawling counties. In addition, people living in more sprawling counties are more likely to suffer from high blood pressure. These results hold true after controlling for factors such as age, education, gender, and race and ethnicity. One does not need a Harvard study to establish another correlation: The correlation between the decline in physical activity and skyrocketing health-care, Medicaid, and Medicare costs. We build subdivisions without sidewalks, schools without playgrounds, and cities without bike lanes, and then we wring our hands about rising rates of overweight, obesity, and chronic disease. We systematically neglect wellness, fitness, and common-sense disease prevention and we are shocked, shocked that health care costs are ravaging Federal, State, and corporate budgets. Someone once defined insanity as doing the same old thing over and over again and expecting a different result. Well, our current health care approach is, by definition, insane. In fact, in America, today, we don't have a true health care system, we have a sick care system. If you are sick, you get care. We continue to spend hundreds of billions on pills, surgery, treatments, and disability. But we are under- funding, cutting or eliminating programs designed to keep people fit and well and out of the hospital. We cannot go on like this. We are choking our economy. We are exploding the Federal budget. And we are, literally, killing ourselves. Consider the obesity epidemic. Some 65 percent of our population is now overweight or obese. The incidence of childhood obesity is now at epidemic levels. Alarm bells are going off all over the place. But our Government has done virtually nothing. And the Federal budget is being eaten alive by health care costs. It is also State budgets. It is family budgets. And it is corporate budgets. Look at the numbers. Last year, nationally, we spent more than $100 billion on obesity alone. Medicare and Medicaid picked up almost half of that tab. This is unwise. It is uneconomic. And, as we now know, it is totally unsustainable. If we are going to control Medicare and Medicaid costs, and private-sector health care costs, as well, we need a radical change of course. We need a fundamental paradigm shift toward preventing disease, promoting good nutrition, and encouraging fitness and wellness. This will be good for the physical health of the American people. And it will be good for the fiscal health of Government, corporate, and family budgets. That is exactly what this amendment is about. Yes, this amendment is a step towards reducing the burdens and stresses on our transportation system. It will improve safety for pedestrians and bikers. By encouraging walking and bicycling, it will also have significant health benefits. And, as a consequence, it will help to hold down health care costs and reduce the burden on Medicare and Medicaid. Now let me explain the specific ways that my amendment will help us to capitalize on these opportunities. My amendment asks the Secretary of Transportation to report to Congress each year as to how the Federal research dollars provided in this legislation are advancing progress on safety and other issues related to walking and bicycling. It also asks the Secretary to establish goals for increasing walking and bicycling, and to set milestones toward achieving these goals. Looking into the future, it asks each State department of transportation to have a policy statement on ``complete streets,'' so that when they undertake projects funded under this highway bill, some consideration must be given to the needs of non-motorized users. Larger metropolitan planning organizations--that is, regional transportation agencies serving 200,000 or more people--can choose to adopt a ``complete streets'' policy or satisfy certain criteria in their planning process. And these agencies must show how their long- range plans and transportation improvement programs will increase walking and bicycling. It does not require that sidewalks or bikeways be built along side rural roads or intercity roads. Finally, under my amendment, these large metropolitan planning organizations, or MPOs, are encouraged to work with their local governments on improvements designed to increase biking and walking. In addition, the MPOs would be directed to designate a bicycle and pedestrian coordinator, a move that would be in line with a requirement placed on state transportation departments dating back to the 1991 ISTEA law. Each of these provisions is designed to better align our current law practices with key features of the bill before us. In the SAFETEA bill, the committee has provided for important financial commitments to bikes and trails. But we need to fully integrate the needs of pedestrians and bicyclists into the complete transportation process. There are also provisions in my amendment regarding how we conduct Federal research activities. This is designed to expand our knowledge of effective pedestrian and bicycle safety practices, and to help our State and local partners understand the best methods and practices for addressing these safety needs. Provisions in this ``Complete Streets'' amendment will help us to ensure that we are designing transportation projects, up front, with pedestrian and bicycle safety in mind, so we don't have to keep going back and retrofitting. So many of the programs in the SAFETEA bill involve re-doing and retrofitting what we didn't do right in the first place. In the future, as each State adopts a ``Complete Streets'' policy, this can be avoided. Finally, this amendment attempts to set modest goals for increasing the number of walking and bicycling trips, while reducing pedestrian and bicycle fatalities. I believe that this modest package of policy improvements can and will make a significant difference. I am very pleased by the broad range of organizations that enthusiastically endorse this amendment.

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

Mr. HARKIN. Yes.

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

Mr. HARKIN. Mr. President, I ask unanimous consent to set aside the pending amendment, and I call up amendment No. 618 and ask for its immediate consideration.

Mr. HARKIN

Mr. HARKIN. Mr. President, I would like the Record to indicate that yesterday I was necessarily absent for the vote on the Talent amendment to the Highway bill, but had I been present I would have voted in favor of the amendment.

Mr. HARKIN

Mr. HARKIN. Mr. President, today, I am proposing to strike the consumptive demand clause from Section 307 of the Tariff Act of 1930 (19 U.S.C. 1307). Section 307 prohibits the importation of any product or good produced with forced or indentured labor including forced or indentured child labor. The consumptive demand clause creates an exception to this prohibition. Under the exception, if a product is not made in the United States, and there is a demand for it, then a product made with forced or indentured child labor may be imported into this country. Let us be clear: forced or indentured labor means work which is extracted from any person under the menace of penalty for nonperformance and for which the worker does not offer himself voluntarily. Let us be really clear: this means slave labor. In the case of children, it means child slavery. Some examples of goods that are made with child slave labor include cocoa beans, hand-knotted carpets, beedis, which are small Indian cigarettes, soccer balls and cotton. Throughout my Senate career, I have worked to reduce the use of forced child labor worldwide. In 2003, my staff was invited by Customs to meet with field agents on Section 307 to discuss what appropriations were needed to enforce the statute. At the meeting, the field agents reported that the consumptive demand clause was an obstacle to their ability to enforce the law that is supposed to prevent goods made with slave labor from being imported into the United States. The consumptive demand clause is outdated. Since this exception was enacted in the 1930s, the U.S. has taken numerous steps to stop the scourge of child slave labor. Most notably, the United States has ratified International Labor Organization's Convention 182 to Prohibit the Worst forms of Child Labor. Currently, 152 other countries have also ratified this ILO Convention. Retaining the consumptive clause contradicts our international commitments to eliminate abusive child labor. Maintaining the consumptive demand clause says to the world that the United States justifies the use of slave labor, if US consumers need an item not produced in this country. There should be no exception to a fundamental stand against the use of slave labor. it is my hope that Congress will act. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. HARKIN

Mr. HARKIN. Mr. President, today, I am proposing to strike the consumptive demand clause from Section 307 of the Tariff Act of 1930 (19 U.S.C. 1307). Section 307 prohibits the importation of any product or good produced with forced or indentured labor including forced or indentured child labor. The consumptive demand clause creates an exception to this prohibition. Under the exception, if a product is not made in the United States, and there is a demand for it, then a product made with forced or indentured child labor may be imported into this country. Let us be clear: forced or indentured labor means work which is extracted from any person under the menace of penalty for nonperformance and for which the worker does not offer himself voluntarily. Let us be really clear: this means slave labor. In the case of children, it means child slavery. Some examples of goods that are made with child slave labor include cocoa beans, hand-knotted carpets, beedis, which are small Indian cigarettes, soccer balls and cotton. Throughout my Senate career, I have worked to reduce the use of forced child labor worldwide. In 2003, my staff was invited by Customs to meet with field agents on Section 307 to discuss what appropriations were needed to enforce the statute. At the meeting, the field agents reported that the consumptive demand clause was an obstacle to their ability to enforce the law that is supposed to prevent goods made with slave labor from being imported into the United States. The consumptive demand clause is outdated. Since this exception was enacted in the 1930s, the U.S. has taken numerous steps to stop the scourge of child slave labor. Most notably, the United States has ratified International Labor Organization's Convention 182 to Prohibit the Worst forms of Child Labor. Currently, 152 other countries have also ratified this ILO Convention. Retaining the consumptive clause contradicts our international commitments to eliminate abusive child labor. Maintaining the consumptive demand clause says to the world that the United States justifies the use of slave labor, if US consumers need an item not produced in this country. There should be no exception to a fundamental stand against the use of slave labor. it is my hope that Congress will act. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. HARKIN

Mr. HARKIN. Mr. President, I rise today to honor a native Iowan and a remarkable athletic champion, Kip Janvrin. Late last month, just 3 months shy of his 40th birthday, he accomplished the amazing feat of winning the decathlon at the Drake Relays for the 15th time. Overall, Kip has finished 85 of the 88 decathlons he has entered since 1983. He has won 38 of them, which is a world record. The Drake Relays are one of the Nation's most prestigious track and field events, held each spring at Drake Stadium in Des Moines. This year, the 96th annual Drake Relays, Kip took the field for the last time in an event, the decathlon, that he has dominated at Drake for 22 years. Over the years, the words Drake Relays and Kip Janvrin have become virtually synonymous. From Jesse Owens to Wilma Rudolph, Gwen Torrance, Carl Lewis and Michael Johnson, the Drake Relays have seen almost all of the great Olympians in track and field. But one Olympian, Kip Janvrin, has been a dominant presence for more than two decades, competing in what is arguably the most grueling and demanding event in all of sports. If the cheers at Drake are especially loud for Kip, it is because he is a native son of Iowa, raised in Panora and a graduate of Simpson College in Indianola. It is fitting that the last year for the original Drake Stadium will also be the last year that this American original competes in the Relays. Kip is one of the top-ranked decathletes in the world, and he is the oldest active U.S. competitor in this extraordinarily demanding event. The decathlon is a 10-event competition which takes place over 2 days. It includes the 100-meter dash, long jump, shot put, high jump, 400 meter dash, 110 meter hurdles, discus, pole vault, javelin and 1,500 meter run. Kip began competing in the decathlon in 1983, and quickly excelled in all 10 events. While attending Simpson College, Kip competed many times in the Drake Relays. His first victory came in 1987. His 15 championships at the Drake Relays are the most by any athlete in the history of that event. In 1998, he was inducted into the Drake Relays Hall of Fame. During his years at Simpson, he earned three NCAA titles in the decathlon, and two more NCAA titles in individual events. He was inducted into the Simpson Hall of Fame in 1998, and the NCAA Division III Track and Field Hall of Fame in 2004. Kip's accomplishments are nothing short of amazing. He holds the world records in career victories, in scores over 7,000 points, and in consecutive finishes. He also holds the world record for the double decathlon, a demanding event involving every event in track and field, except for the marathon and walks. Kip won the decathlon at the 1995 Pan American Games. As a member of the U.S. Olympic team at the 2000 Games in Sydney, Australia, he was the oldest decathlete ever to compete for the United States. In 2001, he won the decathlon at the USA Outdoor Championships. Last year, Kip came in second at the Drake Relays, the first time in 9 years that he did not come in first. However, Kip took the loss in stride, because the victor was his protege, Travis Goepfert, also a native of Panora, IA. Kip is currently in his 15th year as co-head coach at Central Missouri State University in Warrensburg. He and his wife, Teresa, have two sons, Jaxon, age 9, and Mason, age 7. So as Kip Janvrin savors a victory in his final Drake Relays, I extend my congratulations and best wishes. With his self discipline, his commitment to excellence, and his enormous human decency, he represents Iowa at its very best. Win or lose, he has always been a true champion.

Mr. HARKIN

Mr. HARKIN. Mr. President, May 8 to 14 is National Women's Health Week and a time that we should take a careful look at the state of women's health in this country and in particular look at the lack of equality that still exist for women in access to health care. I have long been concerned about the status of women's health care policies in the United States. That is why I have supported several bills and policy changes to improve women's health status. For too long, the Federal Government failed to recognize the health differences between men and women. For example, for many years clinical trials run by the Food and Drug Administration, FDA, often excluded women. As a result, safety and efficacy standards failed to take into account the physiological differences between men and women. That is why I have worked with the FDA to increase the number of women included in these important clinical trials. One way to ensure that we continue to make steady improvements on women's health issues is to ensure that our public health agencies work in a coordinated manner to consider the public health impact on women of a range of health issues. We can accomplish this goal by passing the Women's Health Offices Act, which statutorily establishes Offices of Women's Health at all of our public health agencies. While we have made progress we need to continue efforts to focus on the fact that women's health research is key to the future of improving and saving more lives. As a result of such research, death rates have decreased for women with tumors of the cervix, breast, uterus, and ovary. Quality of life has also improved for cancer patients through the development of less invasive surgical techniques, organ-sparing treatments, and better control of pain and nausea related to chemotherapy. Women's health is an issue I take very seriously. My two sisters both had breast cancer and died of the disease, in a time before regular mammograms and improved treatment methods were widely used or available. I believe that we must work together in a bipartisan manner to refashion our health care system so that all Americans, especially women, have access to the high quality care they deserve at an affordable price.

Mr. HARKIN

Mr. HARKIN. Mr. President, today I extend my appreciation to my spring 2005 class of interns: Sarah Krantz, Matt Hill, Lauryn Douglas, Matt Drake, Stephanie Strasko, John Anderson, Ben Taylor, Stacey Shin and Kathryn Anderson. Each of them has been of tremendous assistance to me and to the people of Iowa over the past several months. Since I was first elected to the Senate in 1984, my office has offered internships to young Iowans and other interested students. Through their work in the Senate, our interns have not only seen the legislative process, but also personally contributed to our Nation's democracy. It is with much appreciation that I recognize Sarah, Matt, Lauryn, Matt, Stephanie, John, Ben, Stacey and Kathryn for their hard work this spring. It has been a delight to watch them take on their assignments with enthusiasm and hard work. I am very proud to have worked with each of them. I hope they take from their spring a sense of pride in what they have been able to accomplish, as well as an increased interest in public service and our democratic system and process.