Daniel Inouye

Mr. INOUYE

Mr. INOUYE. I move to lay that motion on the table. The motion to lay on the table was agreed to. Several Senators addressed the Chair.

Mr. INOUYE. I move to lay that motion on the table. The motion to lay on the table was agreed to. amendment no. 2407

Mr. INOUYE. I move to lay that motion on the table. The motion to lay on the table was agreed to. amendment no. 2416

Mr. INOUYE. I move to lay that motion on the table. The motion to lay on the table was agreed to. [[Page S 12191]] amendment no. 2419

Mr. INOUYE. I this is an amendment to eliminate an obstacle to the quick redevelopment of closing military bases.

Mr. INOUYE

Mr. INOUYE. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. INOUYE. Mr. President, on behalf of Senator Dorgan, I yield the remainder of his time.

Mr. INOUYE. I suggest the absence of a quorum.

Mr. INOUYE. Mr. President, I must oppose this amendment. Much has been said, but there are two items. One, it is the policy of this Nation--and we have an act that says we shall promptly pay our debts; that is the law of the land and the policy of the land, to make prompt payments. Second, among the many reasons we used to justify this change was a very simple one. We have gone through a very painful period in the history of our Defense Department, a period of BRAC. As a result, many fine companies, many manufacturing plants have had to close their doors or to send yellow slips to their employees. And we felt that by speeding up the payment process, we would save them money and provide them the resources to recoup. Mr. President, it is true that when we went from 30 days to 24 days, we knew it would cost the Government about $700 million. We could have amended the Prompt Payment Act and gone from 30 to 36 days, and we would have saved--if that is the argument--$750 million. But we felt that the time had come that with this pain that we are inflicting upon the people of the United States, we should do whatever we can to provide some relief. Keep in mind that for each large procurement--take the B-2--it is not the big companies that are involved; there are 200 small subcontractors. They are the ones who want prompt payment; they are the ones who will suffer, and they are the ones who send out the pink slips. So, Mr. President, I must oppose this amendment.

Mr. INOUYE. I have no objection.

Mr. INOUYE

Mr. INOUYE. Yes.

Mr. INOUYE. Mr. President, I support my chairman, and I am opposed to this amendment. No. 1, the Marines want it and need it. It is of the highest priority. No. 2, the master plan of the Defense Department calls for the acquisition of this 12th LHD. And No. 3, there is no question that we have a good deal at this time. If we do not buy according to the contract of this day, we purchase it in the year 2000, we are looking at a $2 billion tab.

Mr. INOUYE

Mr. INOUYE. Let me assure the Senator from New Hampshire that the committee did carefully consider this matter. It is the view of Senator Stevens and myself that the language in our legislation provides authority to move forward with the second ship in the MPS Enhancement Program. I expect this issue will be further explored during conference, as well.

Mr. INOUYE. I yield the floor.

Mr. INOUYE

Mr. INOUYE. Mr. President, I have only a few observations to add to the other statements that have been made by the chairman of the Budget Committee and the chairman of the Committee on Indian Affairs. Last evening, the chairman of the Interior Subcommittee informed the Members of this body that the policy which guided the subcommittee's action in distributing 45.6 percent of the reductions in the Interior Department's budget to the Bureau of Indian Affairs is one that is aimed at speeding up the process of Indian self-determination and self- governance by sharply reducing funds that go directly to tribal governments for the provision of basic government services for reservation citizens--services such as fire protection, law enforcement, the assurance of health and safety, and the protection of the general welfare of tribal communities. Our colleagues will recognize that this initiative is not dissimilar from that which is being proposed in the area of welfare reform--which is the idea of moving responsibilities out of the Federal Government and placing those responsibilities closest to the people--empowering local communities to address the challenges which confront citizens at that level. But, Mr. President, I believe we must examine carefully what is being proposed under the auspices of self-governance and self-determination, because in the context of reform, we have not and are not asking other Americans to experience a 26-percent reduction in the programs upon which they have come to rely. Rather, we talk about cutting the budget for Federal programs by 5 to 7 percent over the next 5 to 7 years. In stark contrast, we would tell the Indian people that the programs which support the very infrastructure of their governments must be reduced by 26 percent in just 1 year. In stark contrast to the reform measures that we have been debating in recent days, we would tell the Indian people that we are going to shore up and protect the Federal bureaucracy that absorbs 90 cents of every dollar we appropriate for Indian programs and instead, we are going to drastically reduce the ability of tribal governments to address the needs of their citizens at the local level. Mr. President, this is not a proposal that will empower tribal governments. This is a proposal that will devastate the ability of Indian governments to serve the most basic needs of their citizens. As a member of the Appropriations Committee, I understand all too well the constraints and the competing demands that are placed on each of our subcommittees and I understand the challenges with which the chairman and former chairman of the Interior Subcommittee are faced. In the last few days, representatives of the Interior Department have spread horror stories around this body about the impact on each Member's State if funds are taken from any of the six accounts we propose to use as offsets. One Member is told that the Minerals Management Service office in Alaska will be closed. Another Member is told that the wildlife refuges in his State will be closed. There is a story for every Member--and it is always that all of the Interior programs in his or her particular State will be the programs that bear the brunt of our proposed reductions. Unfortunately, these are the kind of desperate and dishonest tactics that are employed when resources become scarce. But I would ask my colleagues, Mr. President, to examine the relative reductions to other programs in Interior, and to understand that a 26-percent cut in the programs that go directly to the Indian tribal governments is a reduction of a size and proportion that we have not asked any of the other Interior programs to bear. It is a matter of simple equity that brings us to this threshold today. Mr. President, we do have a responsibility to preserve and protect this Nation's resources, but we also have a responsibility that we, as a nation, undertook long ago--when we encouraged the Indian nations, by force and solemn commitments, to give us their lands. This responsibility--this trust responsibility--for Indian lands and resources, and to assure the survival of the Indian people--is no less sacred.

Mr. INOUYE. Mr. President, I concur with the chairman of the Budget Committee. The Senator from South Dakota is correct. It is my intent that the important work done by the EROS Data Center will not be affected by our amendment. It is my intent that the offsets from the U.S. Geological Survey will not come from the national mapping, geography, and surveys account to support the amendment that restores funds for the Bureau of Indian Affairs.

Mr. INOUYE. The Senator's understanding is correct.

Mr. INOUYE

Mr. INOUYE. Mr. President, I wish to join the distinguished Senators from Arizona and New Mexico in expressing my words of gratitude to the Senator from Washington for his words of assurance. I thank him very much.

Mr. INOUYE

Mr. INOUYE. Mr. President, I take this opportunity to congratulate Senator Lott for his fine work in drafting a maritime bill with bipartisan support. I look forward to working with him to complete the effort that we initiated last year to reform our maritime laws, and look forward to the enactment of legislation preserving our maritime industrial base. The United States has a long and illustrious maritime history from the privateer fleet of the early eighteenth century, to the fast clipper ships of the mid-eighteenth century, to the incredible build up of Liberty and Victory ships so integral to our victory in World War II. In the past, when we called on the U.S. merchant marine, they delivered the goods. Absent some government action, we are facing the prospect of not being able to call on the merchant marine again. For years, we have heaped requirements on the U.S.-flag operators. These requirements have made it more expensive to operate as U.S. flag. Meanwhile, foreign-flag competitors have been allowed to take advantage of regulatory regimes that have less stringent safety, tax, and labor law requirements. The United States is the world's only remaining super power. However, we may be facing the prospect of having to charter foreign-flag vessels for U.S. military support. This may put us in the position of hoping that the next military conflict is internationally supported and provides an opportunity for the safe transportation of foreign-flag chartered vessels. The Department of Defense has spent billions of dollars building up a reserve fleet of cargo vessels. Unfortunately, a policy to cost-effectively crew those vessels has not been developed. As I speak, U.S. marines on Ready Reserve Force vessels are performing transportation missions in support of Operation Quick Lift, the U.S. government's contribution to the United Nations Reaction Force for Bosnia, while under fire in Croatia. I question whether foreign shipping interests would be interested in evacuating military personnel and supplies from the war zone. Without the passage of this legislation we will be facing the prospect of relying on foreign shipping to achieve our national security and economic security objectives.

Mr. INOUYE

Mr. INOUYE. Mr. President, 200 years ago when our Founding Fathers were engaged in the formation of this great Nation of ours, they gave much thought to the relationship of the new country and Indian Nations. And if one should read the debates of the Continental Congress and look at the Constitution, you will note that our Founding Fathers recognized the sovereignty of the Indian tribes and reserved for the Congress of the United States plenary authority over the conduct of relations with Indians. Sometime later, following the so-called Indian wars, this Nation of ours entered into treaties with Indian Nations. We, Members of the U.S. Senate, are responsible for ratification of these treaties. History shows that there were 800 treaties entered into between the Presidents of the United States, representing our country, and the heads of the Nations of Indians. Of the 800 treaties, Mr. President, history tells us that 430 were ignored by this body--they are still in the files--370 were ratified, and of those 370, every one was violated. We have a perfect score. These treaties, as my colleagues from New Mexico and Arizona have stated, were eloquent documents. They spoke of the sun rising in the east and setting in the west, and when the waters flow from the mountains to the rivers, for as long as this happens, this land is yours. And these treaties promised the Indians 550 million acres. The circumstances of history now cause the remainder of 15. What happened to the 500 million acres? But for these treaties, these Indians made a downpayment to our country. They paid for their health, education and their survival. One would think that after such treatment that they would hate this country. To the contrary, Mr. President. In 25 days, the people of this Nation will pause briefly to observe the end of World War II. On September 2, 50 years ago, the Japanese surrendered. I think we should recall that in all the wars of this century, on a per capita basis, more native American Indians put on the uniform of the United States Government than any other ethnic group. More of them stood forward and said, ``We are willing to shed our blood and give up our lives for the people of the United States.'' So these people have paid their dues. The ceding to this Nation of their lands, this whole Nation, represents an unprecedented and still unequaled consideration for the obligations that this Government of ours assumed for the protection of lands and resources, provision of health care, education and the guarantee of permanent homelands. It is this prepayment in the form of lands which present-day value far exceeds the national debt and the commitments that were made in exchange for these lands that are so easily either forgotten or discounted in contemporary times when there are competing priorities for diminishing resources. But as my colleagues from New Mexico and Arizona have stated, ours is much more than a moral obligation, as the U.S. Supreme Court has repeatedly and consistently underscored over the years. Ours is no less than a legal obligation of the highest order, for their is no other group of American citizens for whom the United States has assumed a trust responsibility or legal relationship of this special nature. There is also no other group of Americans that have been forcibly removed from their aboriginal homelands and placed on reservations on some of the most desolate lands in the country. And there is probably no other group of Americans whose lives are more directly affected by the actions and inactions of our Government. We are not here to undo the history of misery and deception. But we are hoping that, by the action of this Senate, we will not compound this history. I just hope that my colleagues will join my distinguished friends from Arizona and New Mexico to, in some small manner, undo some of the wrongs that we have committed. Mr. President, my colleague from Arizona cited important statistics. The managers of this bill will undoubtedly tell the Senate that, overall, Indian programs were cut by only 8 percent. There are two major accounts. One is the Bureau of Indian Affairs, the other the Indian Health Service. In the Indian Health Service, for very good reason, they increase the amount not to the amount the administration recommended, which was much more, but nevertheless increased it, because the health statistics are such that even a Third World country would be embarrassed to repeat them. As a U.S. Senator, I stand before you, Mr. President, embarrassed to recite these numbers. The mortality rate from tuberculosis among Indians is 400 times the national average; the mortality rate from alcoholism is 332 times the national average; the diabetes-associated mortality rates among the Indians are 139 times the national average; the mortality rate from pneumonia and influenza is 44 times the national average; and as my friend from Arizona indicated, the mortality rate from suicide exceeded the national average by 28 percent. I had the opportunity to visit Alaska on three occasions. On two of these occasions, I went beyond the Arctic circle. There was one village that I was not able to visit because I was told by the authorities that this village was quarantined because 92 percent of the citizens of that village had hepatitis. This is in the United States, Mr. President. I was also told that, in Alaska, for young men between the ages of 20 and 23, the suicide rate was 14 times the national average. Something is wrong. We must do something to bring down these statistics. Quite recently, as chairman of the Indian Affairs Committee, I visited Indian land, and I was horrified to see the health conditions. In a clinic, I saw an x ray machine. I looked at the machine, and this was a World War II vintage x ray machine. I called upon the U.S. Army to look around their inventory to see if they had any spare ones and, yes, they had a few spare ones, so they took it to this clinic. But then they called me back and said, ``We cannot install this because the room there [[Page S 11883]] is not appropriately guarded by lead walls.'' In this clinic, an x ray machine was operating next to the dental clinic with just a one-inch wall separating the two rooms. I am just wondering how many children who got dental treatment there are now suffering from x ray radiation. Mr. President, there are many more statistics, but I find it very difficult to go through them because it is painful. But I hope that in our vote we will try to undo some of this pain and misery. We owe the Indians. They paid for this. My final thought: Anthropologists tell us that at the time of the coming of Columbus, there were approximately 50 million Indians living in what we now call the 48 States. At the end of the Indian wars, just prior to the treaty period, there remained in the 48 States approximately 250,000. We nearly succeeded in wiping out the Indians. If we do not amend this measure, we may succeed. So, Mr. President, let us not compound the misery we have thrown upon the Indians. Let us, for once, do what is right and support this amendment. Thank you very much.

Mr. INOUYE. Yes.

Mr. INOUYE

Mr. INOUYE. Mr. President, I move to table the motion. The motion to lay on the table was agreed to.

Mr. INOUYE

Mr. INOUYE. Madam President, I would like to bring to your attention a matter of serious concern to me regarding the future of our currently superb military forces--and the inextricable link between a quality volunteer force and an equally robust, quality, military health care system. I have followed closely the downsizing of our military forces over the past several years. The Active Force will have come down from 2.1 million service members in 1990 to 1.45 million by 1997, a 32-percent reduction from cold war levels. The Navy will see its fleet reduced from 546 battle force ships to 346 in the same time period with only 12 aircraft carriers in commission by the end of the century. The Army will go from 18 to 10 active divisions and the Air Force from 24 to 13 active fighter wing equivalents. The Marine Corps will likewise be reduced from a force of 200,000 men and women in uniform to a force of 174,000. We have repeatedly promised that there will be no more Task Force Smiths--a tragic result of that period of time just prior to the Korean conflict in the early 1950's when we truly had a hollow force. Yet, I see us slowly but surely moving toward this state of readiness--or should I say, unreadiness. Although it causes me great sadness to even contemplate the repeat of such a tragedy, I must tell you that in the not-too-distant future, I envision us once again being called upon to answer to our brave service members and the American people, ``Why did we let another Task Force Smith occur?'' I have been here long enough to know what is meant by a hollow military. In the 1970's, 25 percent of new recruits were category IV-- the lowest recruitable mental group--and, as a result, 30 percent of our ships--brandnew ships with brandnew equipment--were not fit for combat due to a lack of sailors to man them. For although our military possesses superior technology and superior weapons systems, it is the people who really determine the readiness of our forces. And these people, the men and women in uniform, are recruited from and reflect a cross-section of the American population. Although the services met their recruiting goals last year--and keep in mind that these goals are much lower than they were a few years ago--the military has had to dramatically increase their recruiting budget as well as the number of their recruiters to do so. Even so, it now takes 1.6 times the number of recruiter contacts to achieve one recruit. The reality of our national culture today is that the propensity for young people to join our military is at a 10-year low, down 39 percent among 16- to 21-year old males just since 1991, according to the Army. While it concerns me to watch the reduction of our forces, I understand and support the need to balance the size of our military services with the threats facing us today and in the near future. However, we must not lose sight of the reality that major armed conflicts are still a very real possibility and could come at any time in the form of aggression by regional powers such as Iraq and North Korea. In his recent testimony before the Senate Defense Appropriations Subcommittee, Vice Admiral Macke, the commander in chief of the United States Pacific Command, called North Korea the nation with the highest threat potential today. Dr. Henry Kissinger, in his testimony before the Senate Armed Services Committee in February, warned that ``more and more states are coming into being that feel no responsibility to any global international system or international stability.'' He also cited the North Korean situation, the proliferation of nuclear and other weapons of mass destruction, and the growth of Islamic fundamentalists as serious threats to our national security that could involve us once again in armed conflict. More recently and more frequently, however, we have seen a preponderance of internal regional and national conflicts that require our armed services to respond with operations short of war. These operations not only strain our defense capabilities but drain current year defense budgets. When taken into consideration with other security threats, I become gravely concerned about the speed and direction of our force reductions. Of particular concern to me is the downsizing of the services' medical structure--both peacetime and wartime personnel and units. While I do not wish to tie the hands of the Department or the service chiefs as they restructure their forces, I am increasingly concerned over the severity of reductions to the services' medical departments. In my opinion, the military health service system is being taken down too far, too fast. The military leaders and decision-makers have a tendency to see military health care as less important than the men and women who fly airplanes or who drive tanks. However, I caution you that our military is essentially a team, and if one member of the team is weak, the entire team is weak. Although the medical departments might seem less crucial to the preparation for or the outcome of war, I assure you that to the men and women in combat, they are absolutely essential members of the team. To be effective fighting forces, the servicemembers must be able to concentrate on combat and keep their minds completely clear--free from worry about their own well-being and, even more importantly, free from worry about the health and well-being of their spouses and children at home. Without the knowledge and security that their families are well cared for, our military personnel will lose much of their effectiveness that they have so ably demonstrated during the past decade. First, I will address combat medicine--caring for the soldiers, sailors, marines, and airmen who risk injury and death around the world. When I was injured in World War II, it took 9 hours for me to get to medical care--9 hours. But in 1945 that was not too bad-- Americans probably did not expect any faster battlefield evacuation and care. Today, when a soldier or marine is wounded in combat, he or she can be at the hospital within 15 minutes. In fact, we learned in Korea and Vietnam that if we could get wounded soldiers to hospitals within 15 to 30 minutes--and we did that pretty regularly--we could save most of those who survived their initial wounding. Because of our experiences in these wars, Americans now have come to expect emergency medical services [EMS] systems, 911 phone lines, paramedics with highly technical skills, and advanced EMS and air flight ambulances with sophisticated emergency medical equipment. Most of these capabilities also exist in our military combat health support systems and soon they will have more advanced combat medical technologies such as telemedicine, filmless x rays, and other new medical innovations that will further improve battlefield survival rates. Americans have come to expect this level of care and our service members and their families deserve it. Trauma experts talk of the golden hour--the first hour after initial injury--when the greatest percentage of patient lives can be saved. Let me give you one example. In March 1994, there was a horrible training accident involving soldiers of the 82d Airborne Division on the green ramp--the area where the paratroopers wait to take off--at Pope Air Force Base, adjacent to Fort Bragg, NC. Many soldiers were saved by the expert buddy aid training that [[Page S 10262]] all soldiers receive as part of their combat training. However, many more were saved by the quick response of medical and non-medical personnel who quickly evacuated their comrades to Womack Army Hospital there at Fort Bragg. Several of the most seriously burned soldiers were evacuated to the outstanding Institute of Surgical Research, frequently referred to as the Burn Unit, at Brooke Army Medical Center in San Antonio. And, of course, our world-renowned Air Force evacuation system composed of DC-9 Nightingale aircraft equipped with sophisticated medical equipment and staffed by top-notch flight nurses handled the evacuation of these critically injured soldiers. All of this takes a lot of medical personnel--trained and experienced in emergency care, in trauma care, and in combat medicine--and a lot of medical resources such as ambulances--helicopters, wheeled and tracked ground ambulances, and, yes, even fixed wing ambulances--as we plan for even longer evacuation lines in future conflicts. It means a lot of medical facilities--especially hospitals--located throughout the evacuation pipeline--combat theater and elsewhere. This requires a robust, quality, flexible, military medical force. During Operation Desert Shield/Storm, the military medical operations plan called for emptying almost all of the military hospitals in the continental United States as well as some of those in Europe of medical personnel to deploy with the field hospitals to the Middle East. And that was before downsizing was implemented in the medical departments. Today, the medical departments have lost more than 30 percent of their personnel, but are still expected to provide the same level of support to defense plans that call for conducting two nearly simultaneous major regional contingencies [MRC's], possibly in conjunction with one or more operations-other-than-war [OOTW] scenarios. I would like someone to tell me how this is to be accomplished with 30 percent fewer assets. I would also like to know who will provide care for the military family members in such a situation. As a result of having such a superbly trained and equipped military medical capability, an interesting, but potentially dangerous, precedent has become evident in recent years. Whenever large numbers of people are in need of health care services, whether in this country or elsewhere in the world, the United States military medical departments are requested. You might not be aware of this, but the first U.S. military units to be placed under the command of a foreign nation were medical units. Why? Because we have the most sophisticated, comprehensive, state of the art combat medical capability in the world and other nations sending their sons and daughters off to danger want their soldiers to have the best too. More than just providing combat health services to our deployed service members, a robust health care system is critical to maintaining our quality volunteer force. When the draft ended in 1973, many people both here in Washington and throughout the United States doubted the success of an All Volunteer Force. After all, given the history of the draft and the need to force our citizens to serve their country, how could anyone reasonably expect that there would be enough young men and women who would volunteer to serve--and at a quality that would be acceptable. A great many people were very surprised when the All Volunteer Force not only met previous recruiting standards, but actually exceeded them. I believe we were able to do this in large part because one of the benefits promised to the potential recruits was world-class quality health care, not only for themselves but also for their family members throughout their career and even after retirement. No one said, ``unless we have to downsize.'' I doubt that very many recruiters explained or even understood themselves the fine distinction between ``entitled to'' and ``eligible for'' that separates the statutory provision for health care services for family members of active duty personnel from the retirees and their military dependents. Or that anyone explained about space available care. What the soldiers and sailors and marines and airmen heard, what they were promised, was lifetime health care for themselves and their dependent family members. And how have the services been able to meet their recruiting goals? By continuing to promise lifetime health care for themselves and their eligible family members. Why? Because the military knows that without this benefit, the recruitment of, and particularly the retention of, quality, career service members would be nearly impossible. Now our retirees and service members see us breaking our promises to them. Space available care in our peacetime medical facilities in some cases has already disappeared or is rapidly disappearing for our retirees and, in many places, even active duty family members are forced out on the Civilian Health and Medical Program of the Uniformed Services [CHAMPUS] because of drastically downsized or closing medical treatment facilities. If we continue to cut retirement benefits, we will have a difficult time recruiting soldiers, sailors, marines and airmen for our next war. As Maj. Gen. Jim Pennington, U.S. Army, retired, said, ``If we do not stop this constant effort to renege on the promises to those who have served and kept their part of the bargain, we will destroy the Volunteer Force and consequently our national defense.'' How important is military health care to the service member? I can tell you, it is very important. I have traveled to a great number of military bases and posts and invariably the first or second question I am asked is about health care--usually not for service members themselves so much as for their family members. Much as we would like to believe that there are millions of patriotic Americans willing to serve their country without any additional incentives, the reality is that our service members want pretty much the same thing most Americans want--including families and the ability to take care of their family members. In World War II, only 4 percent of the soldiers had dependents. In 1973, when the draft ended, 40 percent of our military force had dependents. Today, more than 60 percent of our military personnel have family members. When our troops are deployed away from home--and we are asking them to do that more frequently now--their foremost concern is their families. This is just as true, and perhaps even more so, during times of armed conflict. I cannot overemphasize the importance of the military health care system in providing peace of mind and security for our service members and their families, especially when faced with the possibility of deployments and combat as these men and women are every day. Madam President, my concerns with the drawdown of our medical forces are in three areas: The civilian workyear reductions directed at the Department of Defense--DOD, medical readiness, and the continual erosion of retiree health care benefits. Civilian Workyear Reductions The DOD is committed to streamlining its civilian workforce in accordance with the National Performance Review [NPR] and the administration's guidance to increase its efficiency and effectiveness. The DOD seeks to do this without sacrificing quality or compromising military readiness. Between 1993 and 1999, the DOD projects a 32- percent reduction in civilian positions. In accordance with the fiscal year 1996 President's budget, the DOD has targeted headquarters, procurement, finance, and personnel staffs. Downsizing the infrastructure in this way should not affect the military services' ability to carry out their mission nor to respond quickly and effectively. The Military Health Service System's [MHSS] share of these 272,900 civilian reductions is more than 11,000 spaces. However, these positions are predominantly in the business of delivering health care-- nurses, lab technicians, and other medical technicians. Less than one- third of the MHSS civilian work force are in the targeted job series. Although the medical ward clerk or medical transcriptionist might appear to be optional, they are as critical to the health care team effort as are the health care providers. The Congress has been concerned about the adverse impact of downsizing both the military and civilian work force for a number of years. To insure that this downsizing and civilian conversion does not cost the American [[Page S 10263]] taxpayers more in contract and other costs, a number of Federal laws have been enacted in recent years. The Federal Workforce Restructuring Act of 1994, Public Law 103-225, prohibits agencies from converting the work of employees included in the 272,900 civilian reductions to contract performance unless a cost comparison demonstrates that such a conversion would be to the financial advantage of the Government. Section 8020 of the Defense Appropriations Act for fiscal year 1995, Public Law 103-335, provides specific guidance prohibiting the conversion to contract of any DOD activity ``until a most efficient and cost-effective organization analysis is completed on such activity or function and certification of the analysis is made to the Committees on Appropriations of the House of Representatives and the Senate.'' Section 711 of the National Defense Authorization Act for fiscal year 1991, Public Law 101-510, prohibits reductions of medical personnel until the Secretary of Defense certifies to the Congress that the number of personnel being reduced is excess to current and projected needs of the services and that CHAMPUS costs will not increase. And, finally, section 716 of the National Defense Authorization Act for fiscal year 1991 requires congressional notification before any military medical services are terminated or facilities are closed. These restrictions have all been placed on the DOD to ensure that reductions to the MHSS have been thoroughly analyzed for their impact not only on costs, but also on military readiness and preparedness. In my own State, Tripler Army Medical Center staff can expect to pay 30 percent more for child and maternal health care contract personnel to replace existing civilians. And that is for just one medical unit in one hospital. I understand that the U.S. Army Medical Command's [MEDCOM] experience in contracting for health care services indicates that direct hire civilian employees--the same civilians that the DOD has been mandated to cut--are almost always the most cost-effective alternatives when hiring on the margin one for one. For instance, a civilian nurse costs $40,000 per year compared to $60,000 for a contract nurse. At Fort Drum, NY, where contracting care is required because there is no inpatient medical facility on post, the per beneficiary costs are 56 percent higher than costs at similar military installations. In fact, the MEDCOM's experience with commercial activities [CA] studies has shown that it is almost always considerably less expensive for the military system to provide health services than it is to contract for them. The inevitability of these mandated civilian cuts affecting nursing personnel is particularly worrisome, especially in the Army where civilian nurses comprise approximately 50 percent of the work force and where military nurses are being consistently cut more than any other health care profession. As the medical departments downsize, careful consideration must be given to the health professionals such as nurses who are actually providing care. The integration of health promotion, health maintenance, and wellness should be at the forefront of providing quality health care. However, the steep cuts in the endstrength of Army nurses jeopardize the ability of the Army Medical Department [AMEDD] to deliver on its promises to increase access, maintain quality and improve cost-effectiveness of the health care services provided in both peacetime and wartime facilities and settings. With the drastic losses of both military and civilian nurses, the AMEDD has few options other than massive contracting arrangements. If these contract costs were applied across the full spectrum of the MHSS-directed civilian reductions, what would be that cost? I hope that the appropriate DOD personnel are prepared to answer that question, if indeed, we are to draw down medical civilian personnel. It just does not make good business sense to contract out services that can be provided just as well, and far less expensively, in military facilities. Yet, we continue to subject our medical departments to a civilian work force reduction that is intended largely for administrative positions. In addition to the experience of the MEDCOM, I understand that the RAND Corp., in a study commissioned by the DOD to comply with section 733 of the National Defense Authorization Act for 1992, Public Law 102- 190, concluded that medical treatment facilities' in-house care is more cost effective than their civilian counterparts by 24 percent overall and even more in some areas such as primary care. The Civilian Health and Medical Program of the Uniformed Services [CHAMPUS] has not been the preferred cost-effective alternative to either the medical departments who bear the major costs of the program or to the beneficiaries who share the cost. The simple fact is that medical inflation in the private sector has skyrocketed over the past several years. These civilian reductions are all the more disturbing given not only the studies indicating that the MHSS is the most cost-effective alternative, but also given the great strides that the MHSS has made in reorganizing and re-engineering toward a business-like culture. For example, the activation of the U.S. Army Medical Command [USAMEDCOM] in 1994 marked a major milestone in re-engineering the Army Medical Department [AMEDD]. In phase I of that re-engineering, the Army Surgeon General's staff in the Washington area has already been reduced by more than 75 percent. We are all very proud that DeWitt Army Community Hospital at nearby Fort Belvoir in northern Virginia was a recent recipient of Vice President Gore's National Performance Review Hammer Award. The DeWitt Army Hospital's Primary Care Reinvention Plan will dramatically improve the way health care is provided to the more than 140,000 beneficiaries in DeWitt's catchment area. The plan includes the establishment of six new satellite clinics, expanded clinic hours to accommodate working parents, a 24-hour nurse advice system, expanded child and adolescent psychiatric services, and the creation of a special Well-Woman clinic. These initiatives increase primary care access and decrease expensive tertiary care costs. In fact, the MHSS abounds with examples such as these cutting-edge innovations in all of the services. Another long recognized example of the military's enormous contribution to America is the military medical research and development community which is composed of more than 50-percent civilians. These contributions have benefited military readiness, military preventive and curative care, and have impacted tremendously on the kind of civilian health care that has come to be expected by all our citizens. For example, the Army's Medical Research and Material Command [USAMRMC] has unique expertise and facilities for all phases of vaccine development. This includes a hepatitis A vaccine that was recently developed, tested, and demonstrated safe and effective by Army scientists working with SmithKline Beecham Pharmaceuticals. To health care providers, hepatitis A has proven to be a pervasive, but difficult, disease to treat with recovery taking anywhere from several weeks to several months. Hepatitis A is a serious health risk for more than 24 million U.S. citizens that will visit endemic areas this year. In the United States, there are an estimated 143,000 cases occurring each year at a cost of $200 million. This vaccine was the first licensed by the Food and Drug Administration for use in the United States. The MHSS has long been acknowledged as a leader in research and an expert on many diseases throughout the world. Military units deploying to Somalia, the Persian Gulf, Macedonia, and Haiti received comprehensive advice books prepared by USAMRMC on avoiding local health hazards ranging from disease-carrying insects and poisonous snakes to contaminated food and water, heatstroke, and frostbite. This military unique research and expertise has made, and continues to make, massive contributions to our civilian medical capabilities. In fact, as noted in a recent edition of the television program, ``Dateline'', the U.S. military has the only capability in our Nation to deal with an invasion of potentially lethal infectious agents, such as the filoviruses, to the United States. In the area of peacetime medical research, the Medical Research and Materiel Command has led a very successful effort in breast cancer research, HIV-AIDS research, defense women's [[Page S 10264]] health research, and malaria research, to name a few. In fact, the Army's successful management of $236.5 million for breast cancer research in 1993 and 1994 has won high praise from both scientific and advocacy groups. Additionally, they have been able to apply 91 percent of the funds directly to research, thus restricting the administrative overhead to a mere 9 percent. Their success has prompted the Congress to ask the DOD to manage another $150 million for breast cancer research in fiscal year 1995. Other MHSS treatment facilities have similar initiatives underway. Many of these initiatives serve as force multipliers by reducing attrition and enhancing soldier confidence. The U.S. Army Center for Health Promotion and Preventive Medicine [CHHPM] led the effort to develop an outside-the-boot parachute ankle brace that has significantly reduced jump-related ankle sprains common in airborne soldiers. All of these research and preventive medicine initiatives are done for the purpose of improving soldier readiness, providing quality health care for beneficiaries, and improving cost efficiencies. These successful efforts are possible because of the blending of civilian and active duty medical personnel as a team. The active duty personnel infuse new energy and fresh ideas gleaned from their many varied experiences and provide the mobilization force; the civilians provide institutional memory, continuity, stability, and invaluable expertise gained from years of specialized concentration in highly technical fields. To lose either perspective would severely handicap the ability of the MHSS to continue to produce their outstanding results. My final, but by no means least important concern, is of the impact on the morale of the dedicated MHSS civilian employees. Preliminary feedback from Tripler Army Medical Center and other health care facilities indicates that the civilian work force continues to see medical military personnel departing as part of the military drawdown. Yet, the workload has not diminished. The beneficiaries--active duty, retired, and family members--continue to come for the health care they were promised and expect. At the same time, the civilian employees see their own jobs at risk for contracting, probably at greater expense. Our dedicated medical civilians at Tripler and all the MHSS facilities deserve so much better for their dedicated service to their customers--the men and women in our Armed Forces, both present and past. Readiness I am also deeply concerned about the medical readiness of our military units and the impact that downsizing will have upon them. The persistent reductions to the military medical structure from downsizing, civilian reductions, base closures, and bottom-liners-- those faceless men and women who make decisions without having any idea of how it affects people--have resulted in the instability of the medical system. The MHSS is looking at reductions in medical personnel of more than 30 percent at a time when the beneficiary population is decreasing by about 10 percent. Medical readiness is a service-unique responsibility with each service focusing on its mission essential requirements. I applaud joint service cooperation as a means of more efficiently utilizing scarce resources. The medical departments of the services have demonstrated that they can work together in many areas--TRICARE--the DOD's managed care program, telemedicine, research, training and more. However, I am concerned with the increasing pressure to centralize medical readiness and eliminate the individual services' autonomy and flexibility. Each service has a unique culture and specialized roles and missions that cannot be accommodated in an entirely purple suited DOD system. Each must preserve a large degree of autonomy. There is no compelling reason to centrally manage the medical resources of each service under a DOD civilian umbrella. The structure that was created to implement the MHSS's managed care program, TRICARE, is not suited to manage the services' medical readiness assets nor their respective mobilization missions. I, and all of the Congress, will continue to hold each of the service chiefs responsible for military medical preparedness in accordance with their title 10 authority. The military trains for its readiness mission by caring for all categories of beneficiaries in peacetime. This type of training can not be obtained exclusively in a field environment. However, the needs of both the peacetime health care system and the field health care system must be met, in many cases, by the same personnel who must be able to transition quickly and effectively from one system to the other as the mission requires. I am also concerned about the premises upon which several ongoing studies are based for decisions on how downsizing will be accomplished. The Nation and even many of our senior policymakers seem to believe that the recent Persian Gulf war and the Somalia peacekeeping operations are evidence that any future military conflicts will be bloodless affairs--that is, wars where there will be no, or at least very few, casualties. Well, I have been in combat and I can assure you that there is no such thing as a bloodless war. We were very lucky in Desert Storm--just plain lucky. There is no reason to assume that we will be that lucky again or that any adversary will again miscalculate so badly. We must not become complacent and delude ourselves that we no longer need medical personnel, hospitals, ambulances, and other medical assets for combat health care or the resources to enhance and to practice combat medicine. That naive belief is irrational and irresponsible in an age of high-technology weapons of mass destruction and global instability. In the Pacific rim, we need look no further than North Korea to see evidence of a potential conflict that would create thousands of casualties in the first hours of operation. Major military medical centers--like Tripler in Hawaii; the Naval Medical Center, San Diego; Madigan in the State of Washington, and Willford Hall in Texas--must be maintained if we are to be prepared for these conflicts. Any recommendation to downsize these facilities displays ignorance of the lifesaving role these facilities would play. A recent RAND Corp. study titled, ``Casualties, Public Opinion, and U.S. Military Intervention: Implications for U.S. Regional Deterrence Strategies,'' concluded that once deterrence and diplomacy fail and war begins, public opinion demands that the conflict be escalated to bring finality to the operation. Such was the public opinion in the Persian Gulf war. Many Americans would have preferred that United States forces had continued on to Baghdad to overthrow Saddam Hussein, and many still feel that the operation was not completed when it stopped where it did. Assuming that such a view is correct, the resulting military decisions to escalate the measures deemed necessary to win a decisive victory could well lead to more, not fewer, casualties. Our military medical facilities must be structured for such an occurrence. Therefore, other recent study recommendations to downsize or close many of our peacetime medical facilities and to greatly reduce military and civilian medical endstrengths imperil military preparedness. Every day, the dedicated men and women of the military medical departments train in peace for their war mission. To believe that this capability can be contracted out, accomplished in civilian medical institutions, and be made ready for war given a certain amount of time is a certain recipe for disaster. I have heard the argument that we can park our tanks in motor pools when training dollars are short, but we cannot park our eligible health care beneficiaries outside our hospitals. We have seen what happens to readiness when we do so. Not only do the beneficiaries not get the care they deserve, but medical readiness suffers as well. The Nation can no more sacrifice our medical readiness than we can our combat preparedness. I believe the basis for a sound medical readiness posture lies in the medical centers. The medical centers function in much the same way as does a Navy battle group. A modern Navy battle group usually consists of an aircraft carrier, surface warships, support ships, and submarines. The medical centers are somewhat like an aircraft carrier. They are very large and do not [[Page S 10265]] directly engage in combat. They serve as command and control and training centers for the task force and stand ready to launch their expert systems forward as needed. Just as the expert systems of the aircraft carriers are its jets and pilots, a medical center's experts are its military personnel, who work in the medical center during peacetime but staff the field hospitals during wartime or operations short of war, and its telemedicine capabilities. The surface warships and submarines are like smaller hospitals, field hospitals, clinics, and field medical units that directly support the combat mission. These escort ships need the carrier for command and control of its units as well as training for augmentation personnel. Much in the same way, smaller base and installation hospitals and field medical units rely upon medical centers for the establishment of medical policy and procedures--command and control, a pool of qualified and trained clinicians, and projection of its medical expertise forward via telemedicine. The importance of medical centers cannot be overstated. Much of the success of the MHSS is due to its medical centers. They serve as a medical boot camp for health care personnel such as physicians, nurses, and corpsmen; research and development for new medical procedures, programs, and materials; reference centers for world-class medical knowledge and expertise; and the state-of-the-art inpatient care capabilities of modern medicine. One essential type of medical boot camp is Graduate Medical Education [GME]. As with other components of the MHSS, GME has also come under attack. Although it is true that certain segments of military medical GME can be restructured and consolidated, the underlying premise of a medical center-based GME program cannot be refuted. The MHSS benefits tremendously from in-house GME. These benefits include providing specialty and subspecialty care and increases in physician productivity due to the teaching environment. Other benefits include lower patient care expenses, the attraction of more qualified physicians to the academic environment of teaching hospitals, and a higher retention rate of physicians, especially for those trained in military facilities, that leads to lower acquisition and training costs. Opponents of the MHSS would argue that the need for in-house GME would be removed if older, nonactive duty beneficiaries were not treated in MTF's. Again, studies have consistently shown that military in-house care is less expensive than the civilian sector. If we could get Medicare reimbursement legislation passed, the MHSS could continue to provide low-cost care to retirees and ultimately lower the cost of total Federal expenditures. Eliminating GME in the military would force military hospitals to rely on the civilian sector for recruiting physicians--the same system that is currently overproducing specialists and underproducing primary care physicians. Current research literature indicates that only 26 percent of those completing residency training go on to primary care practice. The current mix of specialists is inappropriate for accessible and cost-effective care. We should not force the MHSS back to the high-cost U.S. national average. Our medical centers have also been the projection platforms for telemedicine initiatives. Using commercial off-the-shelf equipment--a digital system camera and a video teleconferencing system, telemedicine enables medical personnel at remote locations to consult with physicians at a medical center and to quickly obtain expert advice on critical or unusual cases. Telemedicine puts the diagnostic firepower of Walter Reed Army Medical Center, the National Naval Medical Center in Bethesda, Maryland, or Tripler Army Medical Center into the hands of the deployed physicians in Somalia, Zagreb, Macedonia, or Haiti. Just this past December 1994, the life of a 26-year-old soldier was saved in Macedonia. This is not so terribly unusual, except that two of the physicians contributed their diagnostic and treatment expertise while observing the patient on a television monitor at the Casualty Care Research Center in Bethesda, MD. Through Operation Primetime, the battalion surgeon with the 1/15th Infantry Battalion, part of the United Nations Observers in Macedonia, maintained telemedicine links with military medical specialists in Europe and the United States. The military medical personnel saved that soldier's life by employing medical care forward--once again demonstrating their function as force multipliers. I am very enthusiastic about the possibilities of expanding telemedicine initiatives even further both in our military settings as well as in appropriate civilian settings. Retiree Health Benefits The last area of military medicine I will address is the continuous erosion of health care benefits for our military retirees and their eligible family members. As the services strive to improve the access and quality of health care through innovative, business-like plans, the massive civilian and military cuts combined with the decreasing health care dollars seriously threaten their future ability to provide health care services to the full spectrum of beneficiaries. The MHSS has embarked on a new managed care plan for non-active duty beneficiaries called TRICARE. The comprehensive health care benefit under TRICARE will maintain or enhance the scope of services that eligible beneficiaries receive today. The MHSS's capability to provide everyday health care will improve with TRICARE, a plan centered around military hospitals and clinics and supplemented by networks of civilian care providers. TRICARE presents an opportunity to clearly define military medicine as essential to force readiness, as well as to improve benefit security and choice of delivery for military beneficiaries. There are parts of this plan, however, that concern me. The TRICARE plan requires our retirees to share in the cost of care, and the greater the choice of physicians they desire, the greater the degree of cost-sharing. This is wrong for two reasons. First, it violates the contract we made with these former servicemembers when they agreed to serve their country in our Armed Forces. We promised them access to free care in our military treatment facilities in exchange for lower wages and often a career of sacrifices during the time of their service. There was no fine print about modest enrollment fees and lower out-of-pocket costs. Second, I pick up the Wall Street Journal and read that, ``HMOs Pile up Billions in Cash, Try to Decide What to do With it,'' as was reported on December 21, 1994. I am outraged that our military retirees, many on fixed incomes, will contribute to these organizations' dilemma. The largest of these are for-profit organizations, growing so fast that they overtook nonprofit HMOs as the dominant force in managed care, as reported by the New York Times, on December 18, 1994. The Nation owes our military retirees and veterans what they were promised. Soldiers, sailors, airmen and marines, their families, retirees and their families, veterans, and surviving family members-- these are the people who comprise the military family. Despite pressures to take a short-sighted view, we must honor our obligations to those who have served faithfully. The Congress and the citizens of this country must do so not only because it is the right thing to do, but because if we do not, we will soon be facing a far more serious crisis--another truly hollow force. We cannot, must not, have contracts that ask more of our retirees and veterans. Any such contract today that does that must be declared null and void with the contract we made with them in years past. We cannot have contracts that restrict access, compromise care, or ask them to make more of a contribution. We placed no such restrictions on our service men and women when we sent them to foreign shores. Lest we think that our servicemembers' tours of foreign shores are a product of days gone by, let me remind you that today we have more than 300,000 servicemembers serving overseas in 146 countries and 8 U.S. territories. In fact, deployments for the Army have increased threefold since 1990 and more than 700 Purple Hearts and two Medals of Honor have been [[Page S 10266]] awarded since November 1989. The military is growing yet another generation of veterans and retirees who have served their country when their country called upon them. I commend the MHSS for their advances in a standard benefit for all beneficiaries, for their commitment to medical advances such as telemedicine, and for the hard work in which they are engaged as they attempt to right size military health care. However, I caution them that I am watching. I will not tolerate a health care system sized on the backs of our retirees, a system that listens more to short-sighted budget analysts than to good business practices, and to any contract that violates the contract this country made with the men and women who served when called and have already paid their dues. Madam President, the real bottom line is that the overall health of the entire voluntary military depends on the health of the Defense Health Program. A compromised military health system will rapidly lead to a compromised military capability. I greatly fear that we are heading down that course. For example, I find it truly alarming that for the first time in our Nation's history, the emergency defense supplemental bill is being offset dollar for dollar from its own defense budget. How long will it be before the Department gets wise and when the President says go to Haiti or Bosnia or wherever, the military says, ``No, thank you, we can't afford it''. I have been involved in our Nation's defense for more than 30 years as a Member of Congress and I have traveled extensively around the world during those many years and I absolutely believe that the best way to prevent war is to prepare for war. The only way to prepare for war is to maintain a healthy, robust military. And absolutely critical to that endeavor is a healthy, robust military medical health system. Let us not forget the painful lessons learned in the past; let us not have another Task Force Smith; let us not repeat the same mistakes. Let us work to ensure a safe and secure future for this great Nation of ours. I would like to acknowledge the contribution of my Congressional Nurse Fellow, Lt. Col. Barbara Scherb, who prepared this statement. Colonel Scherb is an Army nurse who is currently assigned on a 1-year fellowship in my office.

Mr. INOUYE

Mr. INOUYE. Mr. President, I am pleased to announce the reintroduction of the Natural Disaster Protection Act [NDPA] in an effort to create a comprehensive Federal strategy for disaster preparation and planning. I hope that many of my colleagues will join Senator Stevens and me as cosponsors, so that we can ensure that this bill is considered by the full Senate at the earliest possible opportunity. Time, however, is working against us. Since our original legislation was introduced in the last Congress, we have experienced time and time again why the bill is so urgently needed. The earthquake which struck Los Angeles in January 1994 is now rated the second most costly disaster in United States history, adding more than $11 billion to the Federal debt and saddling its victims, most of whom were uninsured, with even greater losses. The tragic earthquake in Kobe, Japan, and the recent California and Midwest floods are just two further examples of nature's unpredictability. This issue is very important to me particularly since Hurricane Iniki struck my State in 1992, causing several billion dollars in damage and widespread economic disruption. Unfortunately, there are millions of Americans who know firsthand about the destruction and suffering caused by these terrible events. What troubles me most is that the worst could still be ahead of us. The U.S. Weather Service predicts that this year's hurricane season, which began a few weeks ago, could be worse than 1992, the year of Hurricanes Andrew and Iniki. I am deeply concerned that we are not prepared for another major natural disaster. That is why we are renewing our effort to enact major disaster policy reform. We simply must insist that all segments of Government, not to mention insurers and homeowners, are doing all that is prudently possible to prevent losses before they occur and to reduce the long term costs of disasters to Federal taxpayers. We need better enforcement of building codes, more thorough mitigation plans, and a funding mechanism that is both predictable and adequate. We must make sure our citizens are protected with adequate insurance so that those at greatest risk from hurricanes, earthquakes, and floods do not end up totally dependent on disaster relief. We must also be certain that such an insurance system is capable of withstanding the worst-possible catastrophes. The NDPA accomplishes these aims and does so with a program that is totally self-funding. This bill advocates private insurance as an alternative to costly Federal relief. It also creates a national disaster fund to assure the availability of private insurance before and after a major disaster and promotes better building practices and increased planning for catastrophes. This legislation would encourage States and local governments to adopt building codes and the type of mitigation strategies I mentioned, and it would provide them with funds derived from private industry, not the Federal Government, to implement those measures. The bill would substantially increase participation in insurance programs for the perils homeowners face and provide for a Federal backstop of the private insurance market in the event of a mega-catastrophe which could result in extreme devastation and economic disruption. The new bill improves upon last year's legislation by relying primarily on the private sector to address insurance availability issues and by modifying Federal disaster assistance programs to reduce the share of disaster relief borne by U.S. taxpayers. The NDPA enjoys the support of numerous State and local government officials, and organizations representing homeowners, consumers, emergency management and response personnel, realtors, lenders, and the insurance industry. It is clear that Members of Congress are beginning to recognize the problem we face in dealing with these catastrophic events and want to do something about it. Must we wait until another disaster on the scale of the Japanese earthquake strikes here in America before we do something? We are committed to bringing this important matter before the entire Senate at the earliest possible opportunity. We need to act now, before it is too late. Accordingly, I urge my colleagues to join Senator Stevens and me in cosponsoring this bill.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise today in support of continuing the funding for the Office of Technology Assessment [OTA] of the U.S. Congress. I believe that if more of my distinguished colleagues, as well as the public, knew what the elimination of the OTA would mean to our deliberative processes, they, too, would support this invaluable congressional resource. Mr. President, there is considerable dedication among my colleagues to reduce the Federal budget deficit and to streamline Federal agencies. This Congress deserves to be commended for bringing the budget deficit, and its burden on future generations, to the attention of the American people more dramatically than ever before. I, too, support the reduction of Federal spending, but only where it makes good sense to do so. However, I ask, what positive affect will the elimination of the OTA--a 143-person, $20 million-a-year agency that performs a great service to the Congress and that potentially saves billions of dollars--have on reducing the budget deficit? Mr. President, many of my colleagues know that the OTA does valuable work and that it is well-managed. However, some argue that the OTA is a luxury that the Congress and the country can no longer afford. Mr. President, I submit that the OTA is not an indulgence, but rather a necessity for the Congress and the Nation. I have frequently turned to the OTA for analysis and information. For example, in 1986, the OTA provided an invaluable service to the Congress and the American Indian community by taking an unprecedented in-depth look at native American health and health care. We learned an enormous amount about both the inadequacies of information technology and the health care delivery systems in the Federal agencies that are charged with implementing our nation-to-nation treaty agreements. As a result of the OTA's study, the Congress will now enjoy a much higher degree of accuracy in reports on the status of Indian health. Let me give you another example of how the OTA has responded to my requests to deliver impartial information. I was one of the first primary requesters of Adolescent Health--OTA, 1991--the first extensive national examination of the scientific evidence on the efficacy of prevention and treatment interventions directed toward improving the health of our Nation's adolescent population. The OTA clearly gave the authorizing and appropriating committees the message that we should not trick ourselves into thinking that by simply labeling Federal initiatives as ``prevention'' of adolescent substance abuse, delinquency, AIDS, or pregnancy, the programs were effective. In fact, many of us on both sides of the aisle were disturbed when the OTA concluded that there was very little evidence of success from the prevention efforts that we had promoted. However, the requesters soon came to realize how valuable it was to receive an open-minded and impartial review from the OTA. And, as the OTA was charged to do, its report went well beyond just giving us the bad news. Because its role is to provide useful information to the Congress, the OTA provided sufficient analysis for us to see where our federally funded prevention efforts were going wrong, and provided guidance to the executive branch on how to better target Federal dollars for adolescent health. I can give you numerous other examples of the OTA's rigorous approach in winnowing through cloudy data in order to provide us with information that is both accurate and useful. For example, since the late 1970's, the OTA has been an often lonely voice in the health care wilderness, carefully assessing whether the country is investing sufficiently in evidence-gathering on health care treatments. Valid information about what works and what doesn't work is critical to the public and private sectors of the health care industry, which represents one-seventh of the Nation's gross domestic product. Senators and staffers need this information as they consider budget requests from the U.S. Department of Health and Human Services, including the upcoming reauthorization for the National Institutes of Health, and proposed reforms to Medicaid, Medicare, and the private insurance market. For example, policymakers need to know the extent to which consumers have sufficient information to choose insurance plans, health facilities and individual treatments. Just recently, the OTA, re- examined how we know what works by looking at new health assessment technologies--OTA, Identifying Health Technologies That Work: Searching for Evidence, September 1994. I recommend that report to all of my colleagues and to their constituents in the health care business. As another example, a health technology study by the OTA in December 1988, Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives: A Policy Analysis, concluded that nonphysician providers were ``especially valuable in improving access to primary and supplemental care in rural areas and * * * for the poor, minorities and people without insurance.'' This information was very helpful in developing health care systems enhanced by the utilization of nonphysician care providers for our underserved populations. Similar, hard-hitting, tell-it-like-it-is analyses have been done by the OTA on subjects ranging from ground water to space. These include classic assessments of polygraph testing, DNA analysis, police body armor, seismic verification of nuclear test ban treaties and other work on weapons of mass destruction, and on risk assessment methods, all of which were greeted with accolades from Members. Right now, the OTA has work under way in areas as important and diverse as [[Page S 9723]] earthquake damage prevention, advanced automotive technologies, renewable energy, wireless communications, and Arctic impacts of Soviet nuclear contamination. Some of my colleagues have suggested that we don't need an OTA--that is, our own group of experts in the legislative branch capable of providing us with these highly technical analyses needed for developing legislation. How many of us are able to fully grasp and synthesize highly scientific information and identify the relevant questions that need to be addressed? The OTA was created to provide the Congress with its own source of information on highly technical matters. Who else but a scientifically oriented agency, composed of technical experts, governed by a bipartisan board of congressional overseers, and seeking information directly under congressional auspices, and given the Congress and the country accurate and essential information on new technologies? Can other congressional support agencies and staff provide the information we need? I am second to none in my high regard for these agencies, but each has its own distinct role. The U.S. General Accounting Office is in effective organization of auditors and accountants, not scientists. The Congressional Research Service is busy responding to the requests of members for information and research. The Congressional Budget Office provides the Congress with budget data and with analyses of alternative fiscal and budgetary impacts of legislation. Furthermore, each of these agencies is likely to have its budget reduced, or to be asked to take on more responsibilities, or both, and would find it extremely difficult to take on the kinds of specialized work that OTA has contributed. I hope that the Congress does not become a body that ignores common sense. If it is to remain the world's greatest deliberative body-- possible only because of access to the best and most accurate and impartial information and analysis--the Congress must retain the OTA.