Jim McDermott

Mr. McDERMOTT

Mr. McDERMOTT. I yield myself 30 seconds. There are 8,300 young adults who are still getting insurance on their parents' plans; more than 8,500 seniors are receiving prescription drug discounts; 86,000 seniors are now receiving preventative care without having to pay for it under the Medicare program; 195,000 now have health insurance that covers preventative care with no co-pays and insurance; and on and on and on it goes. I enter into the Record the health care reform law as it affects the 11th Congressional District of Georgia. Benefits of the Health Care Reform Law in the 11th Congressional District of Georgia committees on energy and commerce, ways and means, and education and the workforce, democratic staff report, july 2013 The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to tens of millions of American families almost immediately after it was signed into law by President Obama. But the largest benefits of the law will become available to consumers on October 1, 2013, when health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. Gingrey's district. It also provides the first picture of the impacts of the law in districts redrawn or newly created following the 2010 Census. As a result of the law: 8,300 young adults in the district now have health insurance through their parents' plan. More than 8,800 seniors in the district received prescription drug discounts worth $12.6 million, an average discount of $620 per person in 2011, $760 in 2012, and $900 thus far in 2013. 86,000 seniors in the district are now eligible for Medicare preventive services without paying any co-pays, coinsurance, or deductible. 195,000 individuals in the district--including 47,000 children and 78,000 women--now have health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 169,000 individuals in the district are saving money due to ACA provisions that prevent insurance companies from spending more than 20% of their premiums on profits and administrative overhead. Because of these protections, over 19,900 consumers in the district received approximately $2.8 million in insurance company rebates in 2012 and 2011--an average rebate of $82 per family in 2012 and $134 per family in 2011. Up to 43,000 children in the district with preexisting health conditions can no longer be denied coverage by health insurers. 248,000 individuals in the district now have insurance that cannot place lifetime limits on their coverage and will not face annual limits on coverage starting in 2014. Up to 129,000 individuals in the district who lack health insurance will have access to quality, affordable coverage without fear of discrimination or higher rates because of a preexisting health condition. In addition, the 45,000 individuals who currently purchase private health insurance on the individual or small group market will have access to more secure, higher quality coverage and many will be eligible for financial assistance. Mr. Speaker, I reserve the balance of my time.

Mr. McDERMOTT. Mr. Speaker, I enter into the Record the effect of the Affordable Care Act on the Sixth Congressional District of Tennessee. Benefits of the Health Care Reform Law in the 6th Congressional District of Tennessee committees on energy and commerce, ways and means, and education and the workforce, democratic staff report, July 2013 The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to tens of millions of American families almost immediately after it was signed into law by President Obama. But the largest benefits of the law will become available to consumers on October 1, 2013, when health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. Black's district. It also provides the first picture of the impacts of the law in districts redrawn or newly created following the 2010 Census. As a result of the law: 5,600 young adults in the district now have health insurance through their parents' plan. More than 9,800 seniors in the district received prescription drug discounts worth $12.7 million, an average discount of $590 per person in 2011, $640 in 2012, and $690 thus far in 2013. 134,000 seniors in the district are now eligible for Medicare preventive services without paying any co-pays, coinsurance, or deductible. 184,000 individuals in the district--including 40,000 children and 74,000 women--now have health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 188,000 individuals in the district are saving money due to ACA provisions that prevent insurance companies from spending more than 20% of their premiums on profits and administrative overhead. Because of these protections, over 26,900 consumers in the district received approximately $3.9 million in insurance company rebates in 2012 and 2011--an average rebate of $69 per family in 2012 and $201 per family in 2011. Up to 40,000 children in the district with preexisting health conditions can no longer be denied coverage by health insurers. 217,000 individuals in the district now have insurance that cannot place lifetime limits on their coverage and will not face annual limits on coverage starting in 2014. Up to 101,000 individuals in the district who lack health insurance will have access to quality, affordable coverage without fear of discrimination or higher rates because of a preexisting health condition. In addition, the 37,000 individuals who currently purchase private health insurance on the individual or small group market will have access to more secure, higher quality coverage and many will be eligible for financial assistance. I now yield 1\1/2\ minutes to the gentlelady from Texas (Ms. Jackson Lee).

Mr. McDERMOTT. Mr. Speaker, I reserve the balance of my time.

Mr. McDERMOTT. Mr. Speaker, I inquire as to whether the gentleman from Georgia is prepared to close.

Mr. McDERMOTT. Mr. Speaker, I yield myself such time as I may consume. I have in my hand here a letter signed by 30 economists from Harvard, Yale, MIT, Stanford, Rice, the University of Chicago, and everybody else, all of whom say we need a mandate. If this mandate were taken out of the law, the Affordable Care Act would be dead. What they say is that the individual mandate does not specify what care people receive; it simply requires people to pay a reasonable amount for any care that they may ultimately receive. No less a conservative than Mitt Romney, the Republican nominee for President, noted when signing the Massachusetts equivalent of the individual mandate: Some of my Libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: either the individual pays or the taxpayers pay. Everyone in this body spends $1,000 a year beyond their own health care costs paying for the uninsured in this country. People walk into the emergency room and they get taken care of because the hospital cannot refuse them and the doctor cannot refuse them, and so they're taken care of and then it's passed on to you and me. The individual mandate says everybody should pay according to their ability. Going on, Mr. Romney said: A free ride on the government is not libertarianism. Everywhere they've tried this without subsidies and mandates, it has failed. They say in the five States that have tried comprehensive insurance market reform without an individual mandate, healthy people choose to stay out of insurance, sick people took it up, and the premiums go up. That's exactly what the CBO says. So what you are saying, by repealing the individual mandate, is you want to drive up the costs on the people who now have insurance. That's a very strange political position to be taking. I must say, I listened to all these people who don't like the individual mandate and all this stuff. If you spend 2 years ranting about the Affordable Care Act and you run a campaign and spend hundreds of millions of dollars and rant against the Affordable Care Act, it's not surprising that people may be a little confused. When I was in medical school in 1963, the American Medical Association spent 3 or 4 years ranting against Medicare; and when the people went out to enroll people for Medicare, they got the door slammed in their face. Old people said, I'm not going to have that kind of government health care in my house. Well, let me tell you something. If you tried to take Medicare out now, you would find you have taken on a really ugly junkyard dog. You're not going to take out Medicare in this country now. You can confuse people for a while, but as they see and as I reported on everybody's district, it is already affecting kids who didn't have insurance because of a preexisting condition; it's affecting kids who didn't have insurance from their job and are now on their parents' insurance; it took away lifetime limits on care; it took away all the things that people worry about when they want health care security. They now have it, and you're saying let's take the individual mandate out and have the whole house come down, because that's what these economists have said. I enter this letter into the Record, and I yield back the balance of my time. Why We Need the Individual Mandate The Patient Protection and Affordable Care Act (ACA) requires people to buy health insurance when they can afford to do so. This ``individual mandate'' is essential to address two features of current health insurance markets: the fact that millions of people cannot afford health insurance coverage, and the fact that insurance companies frequently charge high or unaffordable premiums to people who need insurance most--those suffering from costly illness or injury. This mandate is one of three pillars that together support ACA's private market approach. The first pillar is insurance market reform--ending the ability of insurance companies to discriminate against sick or injured people with high medical costs. Subsidies to help Americans of modest means gain access to affordable health coverage provide the second pillar. The individual mandate provides the third pillar. It requires people to obtain insurance so long as that coverage is affordable. The mandate expresses a basic obligation of citizenship as well as an economic reality. Without the mandate, some people will choose to gamble or to free-ride, undermining the fairness and financial stability of the health insurance system. Few of the uninsured could personally finance medical treatment for a serious illness or injury. Moreover, this country embraces the fundamental principal that everyone should have to minimally decent medical treatment when needed, without regard to ability to pay. Federal legislation and the custom and practice of health care providers embody this principle. A healthy individual's decision to forego affordable insurance coverage thus imposes real costs on others, while raising premiums on many people with serious medical needs who require the most help. The individual mandate does not specify what care people receive. It simply requires people to pay a reasonable amount for any care they may ultimately receive. No less a conservative than Mitt Romney noted, when signing Massachusetts' equivalent of the individual mandate: ``Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on the government is not libertarian.'' The ACA's individual mandate is based on Massachusetts's successful 2006 reforms. That landmark effort covered about two-thirds of the formerly uninsured, while reducing premiums for individual purchasers by about 50% relative to national trends--with strong public support. In contrast, insurance reform without subsidies and mandates has consistently failed. In the five states that have tried comprehensive insurance market reform without an individual mandate, healthy people chose to stay out of insurance, sick people took it up, and premiums increased. Only broad participation in insurance markets can end the cycle of insecure coverage and high costs. The Obama Administration's recent decision to delay ACA's requirement that large- and medium-sized employers sponsor coverage for their employees or pay a penalty is independent of the individual mandate. The employer assessment is designed to bolster the ACA's financing and to ensure equity between large firms who do and do not provide insurance. This assessment will have only a very small impact on employers, since 97% of firms with more than 50 employees already offer insurance. The individual mandate stands in stark contrast, as nearly one in five non-elderly Americans is currently uninsured. Delaying the employer assessment has almost no effect on the implementation of the ACA. The only important effect will be to raise one fewer year of revenue from this component of the law. In contrast, delaying the individual mandate would cut at the core of the vision of private-market based insurance market reform. Requests to delay the individual mandate are really requests to gut the Affordable Care Act. Millions of Americans face immediate health care needs and financial challenges addressed by health reform. They cannot wait. Signers Henry Aaron, Senior Fellow and Bruce and Virginia MacLaury Chair in Economic Studies, Brookings Institution; Kenneth J. Arrow, Professor Emeritus, Stanford University; Susan Athey, Professor of Economics, Stanford Graduate School of Business; Linda J. Blumberg, Senior Fellow, Health Policy Center, The Urban Institute; Len Burman, Director, Tax Policy Center, Urban Institute; Amitabh Chandra, Professor of Public Policy, Harvard University; Philip J. Cook, ITT/ Terry Sanford Professor of Public Policy, Duke University; David Cutler, Otto Eckstein Professor of Applied Economics, Harvard University; Claudia Goldin, Henry Lee Professor of Economics, Harvard University; Jonathan Gruber, Professor of Economics, Massachusetts Institute of Technology; Vivian Ho, Baker Institute Chair in Health Economics, Rice University; John Holahan, Institute Fellow, Urban Institute; Jill Horwitz, Professor of Law, University of California at Los Angeles; Genevieve M. Kenney Co-Director and Senior Fellow Health Policy Center, Urban Institute, Frank Levy, Lecturer, Department of Health Care Policy, Harvard Medical School; Peter H. Lindert, Distinguished Research Professor of Economics, University of California at Davis; Eric S. Maskin, Adams University Professor, Harvard University; Alan C. Monheit, Ph.D., Professor of Health Economics, Rutgers University School of Public Health; Richard Murname, Juliana W. and William Foss Thompson Professor of Education and Society, Harvard Graduate School of Education; Joseph Newhouse, John D. MacArthur Professor of Health Policy and Management, Harvard Medical School; Harold Pollack, Helen Ross Professor of Social Service Administration, University of Chicago; Matthew Rabin, Edward G. and Nancy S. Jordan Professor of Economics, University of California at Berkeley; James B. Rebitzer, Professor of Management, Economics, and Public Policy and Everett V. Lord Distinguished Faculty Scholar, Boston University School of Management; Meredith Rosenthal, Professor of Health Economics and Policy, Harvard School of Public Health; Christopher Ruhm, Professor of Public Policy and Economics, University of Virginia; Jonathan Skinner, James O. Freedman Presidential Professor of Economics, Professor of Community and Family Medicine, Dartmouth College; Katherine Swartz, Professor, Harvard School of Public Health; Paul N. Van de Water, Senior Fellow, Center on Budget and Policy Priorities; Kenneth E. Warner, Avedis Donabedian Distinguished University Professor of Public Health, Dept. of Health Management & Policy, University of Michigan School of Public Health; Stephen Zuckerman, Co-Director and Senior Fellow, Heath Policy Center, The Urban Instituted;

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, on that I demand the yeas and nays.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise today to introduce the Accuracy in Medicare Physician Payment Act of 2013. This bill will give the Centers for Medicare and Medicaid Services (CMS) important tools and resources to continue alleviating our dire shortage of primary care physicians. As Congress tries to come together around the challenges of how to repeal and replace the broken Sustainable Growth Rate formula, I want to make sure that we do not neglect the Medicare physician fee schedule and the impact it has on our physician workforce. It is no mystery that relatively depressed salaries are driving new doctors away from primary-care fields like family medicine and pediatrics and into more lucrative specialties and subspecialties like radiology and orthopedic surgery. I don't begrudge anyone for making that choice; when I graduated from medical school 50 years ago I could not have fathomed being loaded down with six figures of medical school debt. And to be sure, we need talented specialists. But we have a stubbornly small proportion of primary care doctors--just over 30 percent, when most experts agree that 50 percent is the ``sweet spot'' in terms of maximizing quality and minimizing cost. I am proud that Congress gave primary care a shot in the arm in the Affordable Care Act, under which Medicaid pays higher Medicare rates for primary care through 2015, and Medicare makes quarterly incentive payments to primary care physicians through 2017. The ACA also expanded the National Health Service Corps, which eases the steep cost of medical education for doctors and allied health practitioners willing to practice in an underserved area after graduation. These are meaningful steps, but to make more enduring progress in this area, I believe that Medicare must repair structural inaccuracies in the Medicare physician fee schedule that have eroded the value of primary care. Simply put, Medicare contributes to this imbalance by underpaying for the critical yet undervalued job of managing complex patients with multiple chronic conditions and keeping them out of the emergency room and hospital. A major obstacle to reform is Medicare's continued reliance on a committee of mostly specialist physicians to help set payment rates for the 7,400 services on the Medicare physician fee schedule. Since 1991, Medicare has outsourced its work of appraising the value of these services to the AMA's Relative Value Scale Update Committee (RUC)--a 31-member panel of physicians who decide how services should be valued and updated. Only a handful of the 31 committee members perform primary care. The RUC meets in private and provides limited release of the minutes of its proceedings. In formulating its recommendations, the RUC also relies heavily on anecdotal and self-serving surveys, rather than forensic evidence. CMS has begun to update misvalued codes in the fee schedule, but it needs more muscle and resources to do the job. This bill would establish a panel of independent experts within CMS that would identify the distortions in the fee schedule and develop evidence to justify more accurate updates. Medicare could continue to request work from the RUC, but the expert panel would both initiate such requests and review RUC's work product. The panel members would not have a direct interest in the fee schedule, and would include beneficiary representatives. It would be subject to the Federal Advisory Committee Act, which requires advisory bodies to hold open meetings and publish the minutes of such meetings. In addition to payment accuracy and fairness, this is also about reining in a conflict of interest. After looking at this for several years I believe that we give the physician specialty societies, through the RUC, an undue influence on their own payments. In no other area-- whether it be hospitals, skilled nursing facilities, or any other setting--does Medicare ask the providers to play such an active role in setting their own reimbursement amounts. Medicare certainly needs clinical expertise to evaluate the resources necessary to perform physician services but should not look to an outside organization whose members directly benefit from the fee schedule to apportion some $70 billion in annual public spending, without some checks and balances. No matter how well-intentioned, such a system contains structural biases that need safeguards to prevent abuse. Medicare is not only one of America's most important social insurance programs and a bulwark of the middle class, it also establishes economic incentives that ripple through all of health care and contribute to our shortage of primary care physicians. As we continue to pursue a permanent doc fix, let's also talk about how we will use Medicare to incentivize the appropriate mix of physicians in the workforce to serve beneficiaries and the public health.

Mr. McDERMOTT

Mr. McDERMOTT. Madam Chair, I am sad to see that, after failing to get the votes to pass a farm bill last year, Republicans are back at it again, this time with even bigger cuts to SNAP. In this year's House farm bill, H.R. 1947, the Republicans are proposing a cut of $20.5 billion dollars to the program, five times more than what the Senate approved last week. The proposed cuts to SNAP in H.R. 1947 mean nearly 2 million low- income people will lose eligibility for food assistance and 200,000 children will lose access to the free or reduce school lunch program. Of those who still receive benefits, 1.7 million will see a reduction of an average of $90 per month. Additionally, 280,000 people will directly or indirectly lose their jobs. The Republicans are, once again, using a manufactured fiscal crisis to cut aid for the most vulnerable Americans. But let's be honest, the true purpose of cutting food aid to those in need is not to ``balance our budget,'' especially because the evidence shows that these cuts will actually hurt our economy. Implementing short-term cuts that create long-term problems will only slow job growth and increase our deficit. Fiscal responsibility is about meeting our obligations. It is about investing in the American people. It is about growing our opportunities and supporting our economy when the free market won't. What we are deciding right now is whether we ought to eliminate jobs and assistance for people in need over the next 10 years or help them increase their productivity until they no longer need us. We are deciding if we are a nation that takes care of its people or leaves them to fend for themselves when times are tough. It shouldn't be a hard decision to make. Vote against the proposed cuts to SNAP in the House Farm bill.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise today to reintroduce the Duwamish Tribal Recognition Act affecting the indigenous people of metropolitan Seattle. Nearly 150 years after the Duwamish Tribe signed the Point Elliott Treaty in 1855, they are still seeking federal recognition, which was granted to them in 2001 but denied under dubious circumstances eight months later. On March 22, 2013, U.S. District Judge John Coughenour vacated the September 2001 denial of the Duwamish Tribe's recognition by George W. Bush administration officials in the Interior Department. As Judge Coughenour stated, ``plaintiffs should not be left to wonder why one administration thought their petition should be considered under both sets of rules, but a second did not.'' I agree. This issue of Duwamish recognition has been pending for so long that the Interior Department's rules for federal recognition of tribes have changed from the original regulations set in 1978 to those that were revised in 1994. There is significant evidence to support Duwamish recognition that is not in current record, which was filed 20 years ago. I have asked the new Secretary of the Interior Sally Jewell to look into this matter. Meanwhile, this bill would provide federal recognition to the Duwamish Tribe. I urge my colleagues to support this measure. Thank you.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise today to re-introduce the True Cost of Coal Act, a bill that would address the negative impacts of coal transportation on both the local communities and American taxpayers. Currently, plans are underway to develop coal export facilities in the Pacific Northwest that would exponentially increase the volume of coal being exported out of the region. The three proposed terminals-- Gateway Pacific and Millennium Bulk Terminals in Washington and Morrow Pacific Project in Oregon--would export over 100 million tons of additional coal per year. For a sense of scale, the U.S. coal exports in their entirety totaled 125 million tons in 2012. The new terminals would nearly double that total. With these new plans come considerable burdens on the rail communities through which the coal would be transported, including environmental and public health considerations, worsening traffic congestion, and noise pollution, among others. However, without legislation like this, the taxpayers will be largely responsible for these costs. After all, coal and train companies are currently under no obligation to pay for mitigating the effects of transporting coal. That's why I am once again introducing legislation to hold them accountable for the costs that their activities incur. According to the U.S. Energy Information Agency (EIA), the average price per ton of coal exports in 2012 was $118 per ton; the EIA also estimates that in 2012 the cost to ship coal from the Powder River Basin to the Pacific Northwest was only about $20 per ton. The True Cost of Coal Act of 2013 will impose a 10 dollar per ton excise tax on all extracted coal. This money will be used to mitigate the negative impacts of coal transportation and ensure the true cost of coal is paid for by the responsible parties--not the local communities and American taxpayers. The money is allocated to the affected States, who are in the best position to determine how best to use their funds. The Act also requires that trains transporting coal be covered or treated to ensure that no coal dust is released during transportation. I have long been a champion of preserving the clean air and water that Washingtonians cherish. I am pleased to be continuing that work and hope my colleagues will join me in supporting this legislation.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, right now, all across this country, American families are looking at an average of $15,000 of credit card debt. The average student loan debt is double that. I'm sure each and every one of those families would like the option of saying, ``no thanks, I'm not interested in paying those bills.'' But they can't. Americans don't get to skip out on repaying their debt without drastic consequences. Why should Congress get to play by separate rules? When we talk about the debt ceiling, we're not talking about our spending habits or curbing our expenses; we're talking about fulfilling the promises we've already made. We can't debate our budget after we've received what we bought. The last time we played chicken with the debt ceiling, we deeply hurt our credit standing in the world. And we don't have to guess why we were downgraded: Standard and Poors directly told us that is was on account of the political circus the debate had become. Luckily for us, America still enjoys one of the highest credit ratings in the world, but with continued turmoil and unnecessary, partisan wars over this, how long do we expect our lenders to hang on? And why are we having this same, foolish fight? In the name of a so- called ``debt crisis'' that even Speaker Boehner and Budget Chair Ryan admitted isn't a crisis. We're threatening vital services and sacrificing the security of our good national credit for a bogus threat, and all the while the real threat to our economy, anemic growth and persistent unemployment, still looms. Americans are tired of phony disasters. They want real solutions. They are tired of political theatre. They want jobs. They are tired of a Congress that can't do anything but bicker and point fingers. They want their representatives to get to work. To default on our debts would be more than irresponsible, it would send us down a path to becoming a banana republic. We are not a nation of deadbeats and delinquents. We pay our bills or we suffer dire consequences. If we in Congress won't do our job, we shouldn't get paid.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I submit an important op-ed concerning our nation in war. Sebastian Junger is an author and documentarian whose work includes the book War and the film Restrepo, which tells the story of a platon of U.S. soldiers in the Korengal Valley in Afghanistan. For the past year, I have been working with Mr. Junger and Karl Marlantes, a decorated Marine veteran and accomplished author, to start a national conversation about what it means for our country to go to war. Mr. Junger's op-ed perfectly encapsulates the reason that Congressman Walter Jones and I introduced the bipartisan bill, H.R. 1492, ``To establish the Commission on America and its Veterans.'' Forty-three years ago, I left the military with a heart and head full of other people's stories from the Vietnam War. As a psychiatrist, I felt the anguish and confusion that my patients experienced as they came home to a country that did not understand, or take responsibility for America's battles abroad. As Mr. Junger points out, ``The country approved, financed and justified war--and sent the soldiers to fight it.'' This is a nation in a perpetual state of war. Vaguely defined missions under banner of combating extremism have desensitized the American people. News comes as someone else's problem in someone else's country. Few understand how it can corrode our nation's fabric. Yet war is not something we can afford to forget. Consider the 1991 Gulf War, a conflict that lasted for less than two months. Today, we continue to spend billions per year paying compensation, pension, and disability benefits to more than 200,000 veterans. 40,000 of those veterans struggle from long-term disabilities, some of which we are still only beginning to understand as part of ``Gulf War syndrome.'' Mr. Junger's reflections on war extend beyond the economic or political dimensions, though both are important for our national security. It's about our moral duty to own the wars our soldiers fight.S0634 Veterans Need To Share the Moral Burden of War (By Sebastian Junger) [From the Washington Post, May 24, 2013] Recently I was a guest on a national television show, and the host expressed some indignation when I said that soldiers in Afghanistan don't much discuss the war they're fighting. The soldiers are mostly in their teens, I pointed out. Why would we expect them to evaluate U.S. foreign policy? The host had made the classic error of thinking that war belongs to the soldiers who fight it. That is a standard of accountability not applied to, say, oil-rig workers or police. The environment is collapsing and anti-crime measures can be deeply flawed, but we don't expect people in those fields to discuss national policy on their lunch breaks. Soldiers, though, are a special case. Perhaps war is so obscene that even the people who supported it don't want to hear the details or acknowledge their role. Soldiers face myriad challenges when they return home, but one of the most destructive is the sense that their country doesn't quite realize that it--and not just the soldiers--went to war. The country approved, financed and justified war--and sent the soldiers to fight it. This is important because it returns the moral burden of war to its rightful place: with the entire nation. If a soldier inadvertently kills a civilian in Baghdad, we all helped kill that civilian. If a soldier loses his arm in Afghanistan, we all lost something. The growing cultural gap between American society and our military is dangerous and unhealthy. The sense that war belongs exclusively to the soldiers and generals may be one of the most destructive expressions of this gap. Both sides are to blame. I know many soldiers who don't want to be called heroes--a grotesquely misused word--or told that they did their duty; some don't want to be thanked. Soldiers know all too well how much killing--mostly of civilians--goes on in war. Congratulations make them feel that people back home have no idea what happens when a human body encounters the machinery of war. I am no pacifist. I'm glad the police in my home town of New York carry guns, and every war I have ever covered as a journalist has been ended by armed Western intervention. I approved of all of it, including our entry into Afghanistan. (In 2001, U.S. forces effectively ended a civil war that had killed as many as 400,000 Afghans during the previous decade and forced the exodus of millions more. The situation there today is the lowest level of civilian suffering in Afghanistan in 30 years.) But the obscenity of war is not diminished when that conflict is righteous or necessary or noble. And when soldiers come home spiritually polluted by the killing that they committed, or even just witnessed, many hope that their country will share the moral responsibility of such a grave event. Their country doesn't. Liberals often say that it's not their problem because they opposed the war. Conservatives tend to call soldiers ``heroes'' and pat them on the back. Neither response is honest or helpful. Neither addresses the epidemic of post-traumatic stress disorder afflicting our veterans. Rates of suicide, alcoholism, fatal car accidents and incarceration are far higher for veterans than for most of the civilian population. One study predicted that in the next decade 400,000 to 500,000 veterans will have criminal cases in the courts. Our collective avoidance of this problem is unjust and hypocritical. It is also going to be very costly. Civilians tend to do things that make them, not the veterans, feel better. Yellow ribbons and parades do little to help with the emotional aftermath of combat. War has been part of human culture for tens of thousands of years, and most tribal societies were engaged in some form of warfare when encountered by Western explorers. It might be productive to study how some societies reintegrated their young fighters after the intimate carnage of Stone Age combat. It is striking, in fact, how rarely combat trauma is mentioned in ethnographic studies of cultures. Typically, warriors were welcomed home by their entire community and underwent rituals to spiritually cleanse them of the effect of killing. Otherwise, they were considered too polluted to be around women and children. Often there was a celebration in which the fighters described the battle in great, bloody detail. Every man knew he was fighting for his community, and every person in the community knew that their lives depended on these young men. These gatherings must have been enormously cathartic for both the fighters and the people they were defending. A question like the one recently posed to me wouldn't begin to make sense in a culture such as the Yanomami of Brazil and Venezuela or the Comanche. Our enormously complex society can't just start performing tribal rituals designed to diminish combat trauma, but there may be things we can do. The therapeutic power of storytelling, for example, could give combat veterans an emotional outlet and allow civilians to demonstrate their personal involvement. On Memorial Day or Veterans Day, in addition to traditional parades, communities could make their city or town hall available for vets to tell their stories. Each could get, say, 10 minutes to tell his or her experience at war. Attendance could not be mandatory, but on that day ``I support the troops'' would mean spending hours listening to our vets. We would hear a lot of anger and pain. We would also hear a lot of pride. Some of what would be said would make you uncomfortable, whether you are liberal or conservative, military or nonmilitary, young or old. But there is no point in having a conversation about war that is not completely honest. Let them speak. They deserve it. In addition to getting our veterans back, we might get our nation back as well.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise today to reintroduce the ``Justice for Wards Cove Act'' to correct a grave injustice against thousands of Asian-American workers that took place over a quarter century ago. In the 1970s, workers of Filipino, Samoan, Chinese, Japanese and Native American descent traveled north during the summer to work in the fish canneries in Alaska. Management at the Wards Cove Packing Company treated these migrant workers differently from white workers. They were forced to eat in separate dining halls, sleep in separate bunkhouses, and were unable to rise to top-paying positions in the company. In 1973, two Seattle Filipino labor activists named Silme Domingo and Gene Viernes led several class-action lawsuits on behalf of these Asian-American and Native American cannery workers alleging discrimination in the workplace. In 1989, the Supreme Court ruled against the Wards Cove workers, in Wards Cove Packing Co. v. Atonio, which became a major impetus for the civil rights community to reverse the tide against employee rights. The result was the Civil Rights Act of 1991, which became the most comprehensive civil rights legislation signed into law since the Civil Rights Act of 1964. However, what most civil rights communities forgot was that in the final hours before passage of the Civil Rights Act, a highly unusual and narrow amendment was inserted by two Senators from Alaska that exempted the Wards Cove workers from the expansive protections against workplace discrimination outlined in the Civil Rights Act. They feared that the Civil Rights Act could be applied retroactively to the workers. The Senators' amendment was inserted in Section 402(b) of the Civil Rights Act, and its sole target was the Wards Cove workers. To date, the Wards Cove workers remain the only people who have been denied the rights promulgated by the Civil Rights Act of 1991. Mr. Speaker, while my bill cannot retroactively alter the Supreme Court's ruling or grant retroactive rights for the Wards Cove workers, it does remove Section 402(b) of the Civil Rights Act of 1991 as a symbolic measure to right the wrong. This is a legislative fight that I started in 1991, when I first introduced this bill. Each time I introduced this bill, it received bipartisan support but was never voted on the floor of the House of Representatives. In 1993, then-President Bill Clinton wrote a letter of support for my bill, stating, ``It is contrary to all of our ideas to exclude any American from the protection of our civil-rights laws.'' Too often, the struggles of Asian-American and other ethnic minorities do not get the attention they deserve by policymakers and law enforcement officials. This issue is about justice and fairness. Mr. Speaker, I ask that my colleagues join me in honoring the Wards Cove workers by supporting this bill.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise today to introduce the Medical Neutrality Protection Act of 2013, which is an updated version of the bill I introduced in the 112th Congress. I have been encouraged by the tremendous support that this bill received since then, including major human rights advocacy groups, medical professionals, U.S. government officials, and medics living abroad who have been persecuted while serving in times of civil unrest. Since I first introduced this bill in July 2011, we have heard of widespread cases, particularly in the Middle East, where the independence of physicians and medics was severely hindered. Unfortunately, the situation remains dire. Many have been arrested, detained, interrogated, and even tortured for caring for the wounded. Countries that do this to their medical professionals do not deserve our military assistance. This bill elevates the protection of medical professionals as a foreign policy priority for the U.S. Government so that countries that violate norms of medical neutrality will no longer be able to receive U.S. military assistance. I first became aware of this issue back in the 1980s during the civil war in El Salvador. The conflict ended in the early 1990s with over 75,000 people killed, some of whom were medical workers who were caught in combat or working in refugee camps. Then, as now, I was concerned that the United States was not doing enough to stop government forces from harming medical workers, who are some of the only unbiased eyewitnesses that we have on the ground. Protecting doctors and health care workers is a nonpartisan issue that should get broad support in Congress and our government. I urge my colleagues to support this measure.

Mr. McDERMOTT

Mr. McDERMOTT. Well, Madam Speaker, it's Thursday. Everybody's going home. Got to have your press release ready. So here we come. The thirty-seventh time they're going to try and repeal the Affordable Care Act. Now, you've heard a lot of nonsense already in two speakers, absolute untruths told right here about killing jobs and about rising premiums. Washington State put out their premiums yesterday, and their premiums for young people are down by 15 percent. All that hyperbole about going up 450 percent, or whatever we hear, is nonsense. It is simply fearmongering and, you know, the deficit comes down, insurance is more affordable and accessible and, at the most, 33 percent have been convinced by this stuff over here. In my home State, people are ready and willing to do it. Our Governor went out and set it up, and we're going to go and do it. Now, the only thing the Republicans are angry about is that ObamaCare's going to become the law. It's being implemented. It's going to be in place in October. It drives them nuts that they can't figure a way to stop it. They've come out here once a month to try and repeal it over and over and over again, and they keep failing. That's pretty close to the definition of mental illness: doing the same thing over and over again and thinking you're going to get a different result. You are not going to get a different result. The fact is that this is about votes. We have a new crop of freshmen who are getting their campaigns ready, and they've got to have that check in the box that says, I voted against ObamaCare. Vote ``no.''

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, in light of ongoing budget discussions and damaging sequestration cuts to programs that help our most vulnerable populations, it is time to end the austerity debate. I urge all of my colleagues to read and consider Paul Krugman's New York Times Opinion piece, ``The Story of Our Time.'' Those of us who have spent years arguing against premature fiscal austerity have just had a good two weeks. Academic studies that supposedly justified austerity have lost credibility; hard-liners in the European Commission and elsewhere have softened their rhetoric. The tone of the conversation has definitely changed. My sense, however, is that many people still don't understand what this is all about. So this seems like a good time to offer a sort of refresher on the nature of our economic woes, and why this remains a very bad time for spending cuts. Let's start with what may be the most crucial thing to understand: the economy is not like an individual family. Families earn what they can, and spend as much as they think prudent; spending and earning opportunities are two different things. In the economy as a whole, however, income and spending are interdependent: my spending is your income, and your spending is my income. If both of us slash spending at the same time, both of our incomes will fall too. And that's what happened after the financial crisis of 2008. Many people suddenly cut spending, either because they chose to or because their creditors forced them to; meanwhile, not many people were able or willing to spend more. The result was a plunge in incomes that also caused a plunge in employment, creating the depression that persists to this day. Why did spending plunge? Mainly because of a burst housing bubble and an overhang of private-sector debt--but if you ask me, people talk too much about what went wrong during the boom years and not enough about what we should be doing now. For no matter how lurid the excesses of the past, there's no good reason that we should pay for them with year after year of mass unemployment. So what could we do to reduce unemployment? The answer is, this is a time for above-normal government spending, to sustain the economy until the private sector is willing to spend again. The crucial point is that under current conditions, the government is not, repeat not, in competition with the private sector. Government spending doesn't divert resources away from private uses; it puts unemployed resources to work. Government borrowing doesn't crowd out private investment; it mobilizes funds that would otherwise go unused. Now, just to be clear, this is not a case for more government spending and larger budget deficits under all circumstances--and the claim that people like me always want bigger deficits is just false. For the economy isn't always like this--in fact, situations like the one we're in are fairly rare. By all means let's try to reduce deficits and bring down government indebtedness once normal conditions return and the economy is no longer depressed. But right now we're still dealing with the aftermath of a once-in-three- generations financial crisis. This is no time for austerity. O.K., I've just given you a story, but why should you believe it? There are, after all, people who insist that the real problem is on the economy's supply side: that workers lack the skills they need, or that unemployment insurance has destroyed the incentive to work, or that the looming menace of universal health care is preventing hiring, or whatever. How do we know that they're wrong? Well, I could go on at length on this topic, but just look at the predictions the two sides in this debate have made. People like me predicted right from the start that large budget deficits would have little effect on interest rates, that large-scale ``money printing'' by the Fed (not a good description of actual Fed policy, but never mind) wouldn't be inflationary, that austerity policies would lead to terrible economic downturns. The other side jeered, insisting that interest rates would skyrocket and that austerity would actually lead to economic expansion. Ask bond traders, or the suffering populations of Spain, Portugal and so on, how it actually turned out. Is the story really that simple, and would it really be that easy to end the scourge of unemployment? Yes--but powerful people don't want to believe it. Some of them have a visceral sense that suffering is good, that we must pay a price for past sins (even if the sinners then and the sufferers now are very different groups of people). Some of them see the crisis as an opportunity to dismantle the social safety net. And just about everyone in the policy elite takes cues from a wealthy minority that isn't actually feeling much pain. What has happened now, however, is that the drive for austerity has lost its intellectual fig leaf, and stands exposed as the expression of prejudice, opportunism and class interest it always was. And maybe, just maybe, that sudden exposure will give us a chance to start doing something about the depression we're in.

Mr. McDERMOTT

Mr. McDERMOTT. Madam Speaker, we haven't done anything in this House all week, and here we are working on a plan on how the government can default on its debts. That's what this is really all about. It reminds me of the derivation of the word ``bedlam.'' Bedlam was a large mental hospital in the middle of London. It was really called ``Bethlehem,'' but people locally called it ``Bedlam.'' This is a policy that came out of bedlam and will create bedlam. If we don't pay our debts, we are going to create problems in our own country, as well as in the world economic system. If you want to lose the United States dollar as the currency that is used by the world, start by not paying your debts. Everybody will say, Why do we want a dollar? Those folks don't pay. That's what you're creating--bedlam--here today. I urge everyone to vote ``no.''

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I would like to commend Denis Hayes and the Bullitt Foundation for developing the world's most environmentally- friendly and self-sustaining buildings right here in Seattle. The Bullitt Center represents a deep commitment to environmental stewardship and redefines our ideas about sustainable development in dense urban areas. By creating the greenest office building on the planet, you have provided the world an example leading the way to our future. The building is an inspiration and represents a milestone in our efforts to leave a smaller carbon footprint for future generations. Each aspect of the Bullitt Center was meticulously planned and evaluated with its striking technical aspects. From its rainwater cistern and photovoltaic panels to its energy transparency and 250 year life span, the Bullitt Center is and will remain a marked departure from what has been previously achieved in large-scale architecture. Your vision reveals the environmental innovation that can be attained and the completion of this building draws attention to the viability for such projects. The Bullitt Foundation's pledge to construct a complex with so many far-reaching goals in sustainability reflects its hard work, determination and resolve. The development of the Bullitt Center stands as an example for Seattle, the United States and beyond as a viable solution to our continued efforts to go green and commit to furthered environmentally sound projects. Through your dedication, conviction and perseverance to establish such a groundbreaking commercial workspace you have set a new standard of achievement for environmental sustainability.

Mr. McDERMOTT

Mr. McDERMOTT. Thank you very much, Denny. Although it makes me sad for the reason we are speaking here today, I am honored to say a few words about my friend, Governor Booth Gardner. A lot of people will remember us as adversaries, and that's true for a brief time. We ran against each other for Governor in 1984, and I lost. Now, it might come as a surprise to you, but I didn't particularly like losing. And so after the election, I went off to a place I had up in the San Juan Islands to lick my wounds on Lopez Island. It's exactly there where Booth found me a few days later. He called and said, I'm going to be up in the area. I have a place over on Shaw Island, and I'll come over and see you. And so he drove his boat over and we met. I had a 40-acre farm, and we walked around the property four times, talking about our visions, about the State, about the election, about the campaign, and where we wanted the State to go, because Booth and I both loved the State of Washington. By the time we landed on my front doorstep, we'd solved all of Washington's problems. Booth had a unique characteristic which I think Denny alluded to, and that is we had a Senator in the State by the name of Warren Magnuson who used to say you can get a lot of things done if you don't care who gets the credit for them. Booth really did believe that. I'd been working on a basic health plan for the working poor in the State for a number of years before he got to be Governor, and I hadn't been able to get it through the Republican Governor and the Republicans in the legislature. It was my passion project: giving the poor who fell outside of Medicaid but were working an opportunity to buy into the health care system in some way. It was one of those gaps between what the Federal Government did and what the private insurers and the employers were doing, and there were lots of people who were working full time but couldn't get health care. So we put together this program. He told me that day when we were talking around that he would do everything he could to get it passed, and he kept his word--also unusual in politicians. He put everything he had into it. And when it was finished, he signed it in the middle of my district in a little clinic called Country Doctor in the middle of the city on Capitol Hill. That bill has helped the working poor of Washington all over the State get medical care and is one of the first public options. It's so good for the State of Washington that Senator Cantwell took it and put it into the Affordable Care Act. It's now in the blueprint for the safety net that we are developing in this session of Congress. So Booth lived on beyond his days. His ideas, his willingness to make something happen, carried into the future, and he never walked around telling anybody about it, just did it. That walk with me, a couple of rivals, was really the beginning of it all. It wasn't only health care. I was the Ways and Means chairman in the Senate, so I had a lot to do with how the budget got put together. But it doesn't matter if you're the Ways and Means chairman or not, if the Governor won't sign it, you can't get it passed. He and I had lots of talks. He was willing to sign a bill that created the largest settlement for women workers in this country under equal pay for equal work. He signed it after a lawsuit that the State had lost, and I convinced him that we ought to settle the case and let women move ahead in the workplace, and Booth said, Good idea. Finding a partner like Booth, one who's willing to get past politics and jump in the deep end with you on some issues that weren't exactly sort of centrist--sometimes he took some real risks--is not a very common thing in politics. But with Booth it was common. The best interests of the State always came first. Although, occasionally I would go over to his office to find him and they would say, well, he's gone. Well, where is he? Well, he's gone up to coach his girls soccer team in Tacoma. He had all kinds of interests and all kinds of concerns about kids, and he was willing to put everything he had into it, both in the office and out of the office. Now, some of his most important work, in my view, and what shows his real character and why I feel bad today, is that when he left the Governor's mansion, he was in apparently good shape, as far as we knew; went off to Geneva to work for the GATT trade organization, and while he was over there, the diagnosis was made of Parkinsonism. Parkinsonism is a very, very difficult disease to cope with. Your mind is active, everything is active; your body just won't cooperate. And Booth had this disease and struggled with it for 20 years, as you've heard. Now, death is a frightening thing for all of us to think about. None of us want to think about death. It's not something that's usual table conversation or much of a conversation out here on the floor. But Booth was willing to look at it straight on, and he was willing to talk about it in a way that few other people were. He wanted to talk about what people's options were; and he saw the suffering, he was going through it himself, and felt that everyone should have the right to choose how they want to end their life. In a final directive, when you go into the hospital, you tell them whether you want them to resuscitate you or not. All of that, he looked at all of that. And the one thing that was obvious to him was that there comes a time when there is no hope, and there is no question when it's going to happen; and people ought to have the right to make their own decision at that point. It's called death with dignity. Now, he took that issue on. Here's a man who's struggling with a debilitating disease of his own, no political advantage whatsoever in doing it, none. But he came and spent his time. He was sick; it was hard for him to get up and talk. Sometimes he could only talk a few sentences and then someone else would have to take the podium because he was unable to continue. There weren't any donors watching. There was no election to be prepared for. It wasn't even an issue that affected him directly, because the requirement of the law was that you had to have two doctors say that you had only 6 months to live, and with Parkinsonism, it's not possible for any physician to say that. So it wasn't something he was doing for himself. It was because he thought it was right for the people of the State of Washington. You rarely find someone with that ability to get out of their own self-interest. He just believed in it. He believed that it was best for the people of Washington, and he wasn't going to let his sickness or anything else stop him from getting it done, and it passed by about a 54 percent majority. Booth was a great man. They say people are--they pass twice, once when they die, and once when people stop telling stories about him. The stories will never stop about Booth. I could stand up here and tell them for a long time. But he was a great man. He was a good Governor, he was a good father, he was a good husband, and he was my partner and my friend, and I'll miss him very much. Rest in peace, Booth. I yield now to Doc Hastings, from Pasco, Washington.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, it is widely accepted, on both sides of the aisle in both the House and Senate, that health care costs are the single major driver of our deficit and that we need better quality health care at lower costs--for our citizens and for our economy. When it comes to implementing carefully crafted gainsharing programs, existing law is in the way. To meet the three goals of (1) decreasing costs, (2) improving quality, and (3) not compromising access to health care services, the ``Improved Health Care at Lower Cost Act of 2013'' (the ``Act'') will require the OIG and CMS to issue regulations that define standards for gainsharing and similar arrangements that will be protected under the anti-fraud laws. The requirements that federal regulators set should include a primary emphasis on quality. OIG has vast experience in approving shared savings programs where the shared savings payment to physicians by the hospital was conditioned upon meeting certain quality metrics. The idea that shared savings payments should take quality into account seems obvious to me; no one should be permitted to share in savings that the hospital accrues without demonstrating that quality either improved, or at a minimum, was not adversely impacted by such arrangements. I am assuming that regulators will draw upon their vast experience with these programs and put in place sufficient protections to guard against fraud, waste, and abuse. Such protections may include requirements around quality; comparisons against historical data; a ceiling on savings that will inure to any given physician; and a requirement that arrangements be reduced to writing to ensure that it easier to identify arrangements that do not comply with the requirements that CMS and OIG set through rulemaking. The Act will allow hospitals and physicians to better align incentives in order to decrease health care costs through allowing certain ``gainsharing'' arrangements. The term ``gainsharing'' refers to arrangements where hospitals share with physicians any reduction in the hospital's costs for patient care that the hospital gets as a result of the efforts of the physician. Currently, gainsharing arrangements are prohibited under several anti-fraud laws. First, the federal Civil Monetary Penalty statute prevents hospitals and physicians from engaging in ``gainsharing'' arrangements. Second, the Office of the Inspector General for the Department of Health and Human Services (``OIG'') has indicated that gainsharing arrangements may implicate the federal Anti-Kickback law. Finally, gainsharing arrangements may be prohibited by the Physician Self-Referral law. Because of the potential legal implications, hospitals and physicians have been reluctant to participate in gainsharing arrangements for fear of prosecution under all of these laws or even under the False Claims Act. Notwithstanding existing law, the government has acknowledged that there is potential benefit associated with gainsharing arrangements. In its 1999 guidance, the OIG said: [t]he OIG recognizes that hospitals have a legitimate interest in enlisting physicians in their efforts to eliminate unnecessary costs. Savings that do not affect the quality of patient care may be generated in many ways[.] Achieving these savings may require substantial effort on the part of the participating physicians. Obviously, a reduction in health care costs that does not adversely affect the quality of the health care provided to patients is in the best interest of the nation's health care system [emphasis supplied]. Then, in 2005, MedPAC issued a recommendation in its Report to Congress that hospitals and physicians be permitted to engage in gainsharing arrangements. In this report, MedPAC stated that: [t]he Commission believes that gainsharing arrangements have the potential to improve patient care and reduce hospital costs as long as safeguards are in place to minimize the undesirable incentives. . . Due to the potential for gainsharing arrangements to encourage physician and hospital cooperation to lower costs and improve care, the Congress should provide the Secretary with the authority to allow and regulate these arrangements. The Secretary should develop rules that allow gainsharing arrangements as long as safeguards exist to ensure that cost-saving measures do not reduce quality or inappropriately influence physician referrals [emphasis supplied]. Finally, in 2008, the Centers for Medicare and Medicaid Services (``CMS'') issued a proposed rule that would have created an exception under the Physician Self-Referral law to protect certain ``shared savings and incentive payment programs.'' In the preamble to the proposed rule, CMS stated the following: [s]hared savings programs have been recognized by stakeholders as an effective means of controlling costs, improving efficiency, and promoting quality in the delivery of health care services. Government stakeholders have recognized similar potential benefits when shared savings programs are properly structured to ensure compliance with Federal health care program requirements. Empirical evidence suggests that the goal of patient care quality maintenance or improvement can be achieved through a properly-designed shared savings program. The rule was never finalized. However, based upon the assertions of OIG, MedPAC, and CMS, the evidence seems clear and convincing: properly structured gainsharing programs show substantial potential in reducing costs by aligning incentives between hospitals and physicians to make cost-saving improvements to healthcare delivery. In sum, the Act strikes the right balance between the need for innovation in promoting cost savings efforts and the need to guard against waste, fraud, and abuse. CMS and OIG can structure the requirements that hospital-physician arrangements must meet in a way that ensures federal health care programs will be protected from fraud, waste, and abuse. Federal regulators have been overseeing these arrangements for nearly a decade--either through demonstration authority or through the advisory opinion process--I am confident that this legislation holds genuine promise for being a ``game changer'' in getting us towards the goal of better care at a lower cost without compromising access to quality health care services.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, today I would like to recognize one of the finest committee staff members to have worked for me, the Ways and Means Committee and the U.S. House of Representatives. Sonja Nesbit joined the House staff over 11 years ago and has made an enormous difference for millions of Americans since the day she arrived. Now she is moving on to the Department of Health and Human Services to continue her work on behalf of the nation's poor, and I want to thank her for her accomplishments, her ongoing dedication to this institution, and for her service to the American people. In Congress Sonja was at the center of our efforts to restructure the national foster care system, a reform that has helped innumerable young people get a better shot at finding a good family and personal and professional success. Sonja also worked tirelessly on the creation of the home visitation program in the Affordable Care Act that promotes home visits for at-risk children. Sonja is a leading expert in her field and is, really, the ideal public servant. She gave thoughtful advice and counsel, helping myself and other members do the right thing for the poor and needy in this country. She was patient, helpful, and always looking for policy that would reflect the values of justice and equality. This is what the American people need in a public servant and in congressional staff. Now Sonja is moving on to work in the Department of Health and Human Services where she'll continue her work on making the country's social safety net just and strong. We will all miss her. I congratulate Sonja on her new position, thank her for her good work, and wish her the best of luck at HHS.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, after a painful decade of war, the United States needs to take the time to regain its equilibrium and find peace. Without a formal process for acknowledging the physical and psychological costs of war, our collective trauma can undermine our country for decades. As Ernest Hemingway wrote: The killing is necessary, I know, but still the doing of it is very bad for a man, and I think that, after all this is over and we have won the war, there must be a penance of some kind for the cleansing of us all. War involves staggering amounts of loss and--equally important--of killing. Despite great efforts by our soldiers to protect civilians, an overwhelming majority of casualties in modern war are innocent people. This incurs a deep spiritual and emotional cost to those who witness it and are sometimes responsible for it. Many initiatives exist that provide help for the men and women who have fought, but we must go beyond the policy initiatives. Soldiers returning from war need to share their experiences and unburden their souls. Our soldiers volunteered to serve their country in war, but they did not volunteer to take over the entire moral burden that comes with it. Our Nation needs to discuss the complicated spiritual and emotional obstacles faced by any society that has waged war. This is not a partisan debate about the rightness or wrongness of war. This is a national effort to take care of our soldiers by publicly sharing some of their burdens. We must be willing to explore the responsibility that comes with asking them to fight. In preindustrial societies, leaders were intimately involved in war, itself--often with a sword in hand--and religious and spiritual leaders were fully engaged in the aftermath. Rituals and ceremonies decommissioned the fighters and made the entire community conscious of the sacrifice. These processes are missing today, and they remain vitally important. The agony suffered by our veterans is vivid testimony: 22 veterans commit suicide every day while an average of almost one active duty soldier a day took his or her life in 2012. That's higher than in combat. Many other soldiers suffer from posttraumatic stress disorder, become addicted to drugs and alcohol, or fall into violence and prison. If a society fails to address these emotional and moral issues publicly, soldiers and vets will struggle with them privately. Many of them will lose that struggle and leave us all affected by their loss. The Nation requires concrete ways to address the wounds of the war. We need a national day of solemn ceremonies that acknowledge the costs in lives, trauma, lost limbs, families, a renewed commitment to the social and health issues of veterans, a discussion about national service for young, nonmilitary Americans, and a systematic interaction between combat veterans and civilians. I worked with Karl Marlantes, who wrote the book ``What It Is Like to Go to War,'' and with Sebastian Junger, who did the documentary called ``Restrepo,'' which was about Afghanistan, in order to create this bill that would address these issues. We propose a commission to examine and articulate the spiritual challenges and to help heal the psychological wounds faced by a Nation emerging from a decade of war. We call on the President, on the Senate majority and minority leaders, and on the House Speaker and minority leader to appoint a group of distinguished citizens to explore ways to heal this society. The committee should include veterans, spiritual leaders, psychologists, journalists, maybe even a poet. It should strive to reach beyond the politics of war and into the true moral and emotional consequences that violence always incurs. It may be hard for us, but we must do it if we are to remain a humane society. Some see things as they are and ask why. I dream of things as they never were. The question we must ask now is: Why can't we do for our soldiers what needs to be done? They need to be taken home and received and understood by the populace for what they went and did for us.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Chairman, the Back to Work budget is the first budget that recognizes the truth about our so-called ``deficit crisis'': we don't have one. Speaker Boehner and Chairman Ryan went on television on Sunday and said that there is no immediate crisis, that it is the unemployment numbers we should be worried about. Now is not the time for austerity. It is the time for the government to invest where the private sector won't. They're sitting on their money, waiting. This is the time to bolster our new and growing industries, like biomedical research and technology. Now is the time to rebuild our infrastructure. Creating jobs, as this budget does, is the only way we will become self-sustaining. With lower unemployment, fewer people need public assistance, and more people pay taxes. That's how you shrink the deficit. That's fiscal responsibility. My Republican colleagues love to talk about balancing household budgets. Well, I don't know any American family that would use its children's lunch money to pay down its credit cards, and that's what they're proposing in the Ryan budget. Most families choose to invest in college educations, health care and retirements, trading current debt for future returns. It's time to choose what kind of country we're going to live in. Do we grow with education, investments and a strong social safety net; or do we cut our way to higher unemployment, instability, and class divide?

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, although I rise to honor the 10th anniversary of the Iraq war, what I really want to do today is ask: Why? Ten years ago, I stood on this floor and said we were entering a war under false pretenses. No weapons of mass destruction later, I have never been so sad as to be right. We took out Saddam Hussein with as much forethought as we gave to arming him just a few years earlier. We scooped him out of office and thought a new democracy would suddenly flower in its place. Last week, Robert Dreyfuss wrote an article in The Nation that I would like to enter into the Congressional Record. He explains that the CIA is currently training Syrian rebels, some of whom have Sunni fundamentalist ties, at the same time that it is fighting Sunni rebels in Iraq. Recently, dozens of Syrian soldiers fled to Iraq, only to be killed by Iraqi Sunnis. He asked the question: When will the United States learn that it doesn't know enough about the Middle East to go charging in there, seemingly without a clue about what it all means? So here we are: 10 years of neoconservative hawks preaching that we can franchise American democracy and freedom; 10 years of quicksand diplomacy; 10 years of wrong answers, and we still don't know the question. What has been the cost of all of this? And I don't mean financially. Because, yes, we've spent probably a trillion or more on this war, or will. Yes, as we speak, we are cutting food assistance to kids in this country and funding for R&D that would drive our economy. But we can't appropriate a sum of money to fix the real cost of Iraq. We can't pay back the lives of 4,486 American men and women who have died there, or the roughly 2,000 broken soldiers who came home and took their own lives. The wounded--physically and mentally. The soldiers who didn't know how not to be a soldier. The families living with a hole in their hearts, and the families living with someone they no longer recognize. Ten years of young men and women leaving their families, living in hell, and coming home to unemployment and to homelessness. To a country that has forgotten it's at war at all. To a country that seems to think a yellow ribbon magnet on their bumper is the only kind of support that our troops need. And the cost in Iraq? Untold deaths. Let me rephrase that: unknown deaths. We can only guess at the destruction that we have left in our wake: 115,000 Iraqis? 600,000? You can find a number. What was the long-term impact of that on their environment, water, and health. What happens when someone lives in constant fear of becoming collateral damage? Today, Iraq is a sad shadow of a society that once boasted the best infrastructure in the region. Instability and violence fester on this very day, and now it teeters on the brink of an inevitable civil war. This is the legacy of our last 10 years, and I still don't understand why. I hope this anniversary will remind us that a whole new generation of veterans are waiting to help reintegrate into civilian life. I believe it's time to elevate our level of commitment to these veterans. I am introducing a bill to create a commission on veterans care to investigate what we as a society can do to help our men and women come home. I hope it will remind us that no lives, regardless of nationality, should be taken lightly. I hope it will remind us as to why the next time. And I hope it won't take another war to get that answer.

Mr. McDERMOTT

Mr. McDERMOTT. What, really, could be more bizarre than this: as the United States ramps up its aid to Syria's ragtag rebels, whose backbone is comprised of radical Islamists and Sunni fundamentalists, some with ties to Al Qaeda, the CIA is busily engaged in combat inside Iraq with the very same radical Islamists and Sunni fundamentalists, some with ties to Al Qaeda. Yep, that's right. We're backing the same guys in Syria that we're fighting in Iraq. Of course, we shouldn't be involved in Iraq in any way, shape or form, but try telling that to the CIA. According to the Wall Street Journal: The Central Intelligence Agency is ramping up support to elite Iraqi antiterrorism units to better fight al Qaeda affiliates, amid alarm in Washington about spillover from the civil war in neighboring Syria, according to US officials. The stepped-up mission expands a covert US presence on the edges of the two-year-old Syrian conflict, at a time of American concerns about the growing power of extremists in the Syrian rebellion. The Journal notes that this isn't an accident. It was the result of a carefully thought-out White House decision: In a series of secret decisions from 2011 to late 2012, the White House directed the CIA to provide support to Iraq's Counterterrorism Service, or CTS, a force that reports directly to Iraqi Prime Minister Nourial-Maliki, officials said. The CIA has since ramped up its work with the CTS--taking control of a mission long run by the U.S. military, according to administration and defense officials. For years, U.S. special-operations forces worked with CTS against al Qaeda in Iraq. But the military's role has dwindled since U.S. troops pulled out of the country at the end of 2011. The paradox, obviously, is that Maliki, the guy we're helping in Iraq, is an ally of Iran's and is sympathetic to President Assad of Syria. That's because were the Sunni-led rebels in Syria to seize Damascus and topple Assad, they'd turn their wrath next door against the Shiite-led Maliki regime, and funnel weapons and fighters to support the Sunni-led rebels in Iraq. That's not stopping the United States, though, from boosting the fortunes of the Syrian rebels by funneling aid and support to them and coordinating the flow of weapons from Saudi Arabia, Qatar and Turkey. Meanwhile, as The New York Times has been reporting for a while, the same CIA that is trying to squash the Sunni rebels in Iraq is actually training Sunni rebels in a secret program in Jordan, to fight in Syria. Oddly enough, the rest of the media hasn't picked up on the Times reports on the CIA training efforts in Jordan, and the Times itself hasn't elaborated. How many gangsters are is the CIA training in Jordan? What are they doing? It all comes together in the recent reports that dozens of Syrian soldiers, loyal to Assad, who fled into Iraq recently, were then massacred by Iraqi Sunni crazies. We blundered, bungling, into Iraq in 2003 without knowing really a damn thing about the country we invaded. When will the United States learn that it doesn't know enough about the Middle East to go charging in there with guns, seemingly without a clue about what it all means?