Bernie Sanders

Mr. SANDERS

Mr. SANDERS. Essentially what the letter goes on to talk about is that many of these organizations have been looking at this issue for years, and in their independent budget have noted that the VA needs more space, because you have many hospitals where there are not enough examination rooms and that slows down the ability of doctors and nurses to treat patients, and we need more doctors and nurses. So for many of these organizations this is not new news. They have known it for years. Here is where we are. The good news is that I think we can bring forth a bill which deals with emergency contracted-out care for veterans today on long waiting periods. I think we can deal with the issue that Senator McCain feels very strongly about and that is making sure that veterans who live 40 miles or more away from a VA facility will be able to go to the private physician of their choice, and I think we can also strengthen the VA in terms of doctors and nurses and information technology and space so that we don't keep running into this problem year after year. It is going to take the VA time in order to bring in the doctors and nurses and do the construction. I don't want to get into the details of the discussions we are having with the House, but I did want to make veterans, and, in fact, Members of Congress aware of where I believe we are at this moment. With that, I will yield the floor.

Mr. SANDERS. I ask unanimous consent that the order for the quorum call be rescinded.

Mr. SANDERS. Mr. President, as chairman of the Senate Committee on Veterans' Affairs, I want to take a few minutes to update Members of the Senate as to where we are on some very important issues that impact veterans all over this country. The first point I want to make is some good news. The committee had a hearing yesterday to hear testimony regarding the confirmation of Robert McDonald to be the new Secretary of the VA. I think I can speak for the whole committee in saying we were very impressed by what we heard from Mr. McDonald both in terms of his passion for the needs of veterans and also his administrative knowledge, his management skills, as the former head of one of the large corporations in America. I think he left us with a very strong impression. The result was that today, a few hours ago, by a unanimous vote, the Senate committee voted to confirm Robert McDonald as our new Secretary of the VA, and I hope very much his nomination will get to the floor as soon as possible. I think that is good news because the VA needs stable leadership. Sloan Gibson, who has been Acting Secretary, is doing an excellent job. He has already accomplished a lot. But it is important that we have a new permanent Secretary on board, and I hope the Members here see fit to confirm him as soon as we possibly can. On an additional issue, I think as all Members of the Senate know, about a month or so ago we voted by a vote of 93 to 3, almost unanimously, to make sure the veterans of our country get quality health care in a timely manner, that we bring a new level of accountability to the VA, and I am very proud of the support that legislation, which was introduced by me and Senator John McCain, received. I thank again Senator McCain for his very strong efforts to make that happen and for his continued support of the veterans community. Senator McCain made a statement the other day--I think it was yesterday--published in CQ, which I personally could not agree with more. He spoke in terms of the conference committee that we are in right now trying to merge the Senate bill and the House bill and come up with something that can pass in both bodies. He said and I quote: ``We've got to sit down and get this done, because we cannot go out for recess in August without having acted on this bill.'' I think he is exactly right. Let me, picking up on that theme, relay to my colleagues what the VFW, which is having their annual convention in St. Louis, said: The Veterans of Foreign Wars of the United States is demanding that Congress immediately pass a compromise bill to help fix the Department Of Veterans Affairs before they adjourn for five weeks at the end of the month. ``Pass a bill or don't come back from recess,'' said VFW National Commander William A. Thien of Georgetown, IN. ``America's veterans are tired of waiting--on secret waiting lists at the VA and on their elected officials to do their jobs.'' I could not agree with the VFW more on that issue. There was a bill a month ago that passed here. The CBO said that bill would cost $35 billion, and we voted for that for emergency funding because the Members here understood that taking care of veterans is a cost of war as much as spending money on tanks and guns and missiles-- $35 billion in emergency funding. The House passed its bill which was later assessed by the CBO at $44 billion. But here is the good news-- and without divulging the kinds of negotiations we are having with Chairman Miller in the House--and Chairman Miller is a serious man. I think he wants to get a bill passed. I don't want to go into all the details here, but I think it is fair to say the cost of that bill will be significantly less than what the CBO originally estimated. A few minutes ago I and others received a letter from the major veterans organizations on an issue of important consequence. Again, without going into great detail about the nature of the negotiations which the House and Senate are having on the veterans bill, I think it is fair to say one of the stumbling blocks is that I agree and the House agrees it is imperative we pass funding to make sure that veterans who are in long waiting lines right now get the quality care they need now, and that means if the VA cannot accommodate them in a timely manner, they will go out to private doctors, community health centers, or whatever, and the VA will pay that bill. That is what we have to do because it is unacceptable that veterans remain on long waiting periods and not get health care. There is a general agreement on that. There is debate about how much that is going to cost over a 2- year period, but I think we can reach some resolution. Here is where the difference of opinion lies--without divulging anything, and this has been in the newspapers--Sloan Gibson, the Acting Secretary, came before the Senate Veterans' Affairs Committee last week and he made it very clear that while we have to deal with the emergency of long waiting periods and get people the contracted care they need, simultaneously, we must make sure the VA has the doctors, the nurses, the medical personnel, the IT, and the space they need in order to deal with this crisis so that 2 years from now we are not back in the same position we are, and he came forward with a proposal that, in fact, costs $17.6 billion. I think we can lower that amount of money, because some of that request is not going to be spent this year or even next year. But the issue here is we have to strengthen the VA, their capacity, so that veterans do not remain on long waiting periods and that we can get them the quality and timely care they need. Now, what I wanted to mention was an hour or so ago I received and Chairman Miller, who is chairman of the House Committee on Veterans' Affairs, got the letter, Richard Burr, who is the ranking member on the Senate committee, Mike Michaud, the ranking member at the House--we received a letter from a variety of veterans organizations, virtually every major veterans organization, and they are the Disabled American Veterans, the Veterans of Foreign Wars, the VFW, the Paralyzed Veterans of America, the Vietnam Veterans of America, the Iraq and Afghanistan Veterans of America, the Military Officers Association of America, the U.S. Coast Guard Chief Petty Officers Association, and many other organizations. I want to take a moment to read what they say, because this is terribly important. What they are saying in essence is yes, we need emergency funding to make sure that veterans tomorrow get the health care they need from the private sector or anyplace else, but we also need to strengthen the VA so that over the years they can provide the quality and timely care veterans are entitled to. I am going to read this letter because it is important that Members of the Senate and the House understand where the major veterans organizations are coming from. Last week Acting Secretary Sloan Gibson appeared before the Senate Veterans' Affairs Committee to discuss the progress made by the Department of Veterans Affairs over the past two months to address the health care access crisis for thousands of veterans. Secretary Gibson testified that after re- examining VA's resource needs in light of the revelations about secret waiting lists and hidden demand, VA required supplemental resources totaling $17.6 billion for the remainder of this fiscal year through the end of FY 2017. As the leaders of organizations representing millions of veterans, we agree with Secretary Gibson that there is a need to provide VA with additional resources now to ensure that veterans can access the health care they have earned either from VA providers or through non-VA purchased care. We urge Congress to expeditiously approve supplemental funding that fully addresses the critical needs outlined by Secretary Gibson either prior to, or at the same time as, any compromise legislation that may be reported out of the House- Senate Conference Committee. Whether it costs $17 billion or $50 billion over the next three years, Congress has a sacred obligation to provide VA with the funds it requires to meet both immediate needs through non-VA care and future needs by expanding VA's internal capacity. And I continue. Again, this is a letter from almost every major veterans organization: Last month, we wrote to you-- They wrote to the chairmen of the House and Senate Veterans' Affairs Committees-- we wrote to you to outline the principles and priorities essential to addressing the access crisis, a copy of which is attached. The first priority ``must be to ensure that all veterans currently waiting for treatment must be provided access to timely, convenient health care as quickly as medically indicated.'' Second, when VA is unable to provide that care directly, ``VA must be involved in the timely coordination of and fully responsible for prompt payment for all authorized non-VA care.'' Third, Congress must provide supplemental funding for this year and additional funding for next year to pay for the temporary expansion of non-VA purchased care. Finally, whatever actions VA or Congress takes to address the current access crisis must also ``protect, preserve and strengthen the VA health care system so that it remains capable of providing a full continuum of high-quality, timely health care to all enrolled veterans.'' I ask unanimous consent that this letter be printed in the Record.

Mr. SANDERS

Mr. SANDERS. I thank Senator Leahy for yielding.

Mr. SANDERS. Mr. President, way back in 1968 as a young man, I got a job at the Department of Taxation in a small building on State Street across the street from the statehouse, working for the administration, then-Governor Hoff, and that was a very important experience for me and helped me shape some of my views which I carry today. Phil Hoff's career of public service began during World War II when he put his studies on hold and joined the Navy, eventually joining the submarine service. He served on the USS Sea Dog in the Pacific theater, going on a number of combat tours in the dangerous waters near the main islands of Japan. While in naval training in New London, CT, a friend of his set up a blind date with a Connecticut college student. Her name was Joan Brower, and she and Phil would be married after the war--a marriage that was to last for six rich decades. I know Senator Leahy and his wife, as well as myself and my wife Jane, know the Hoffs very well. We know Joan and know of her years of dedication to the people of the State of Vermont, especially in the area of education. So she in her own right has been a very important figure in our State. After Phil Hoff's graduation from Cornell Law School, he and Joan moved to Burlington, VT, in 1951. Deeply committed to social justice, he became involved in Democratic Party politics and did that despite the fact that he grew up in a Republican family. Senator Leahy will remember that way back then, there was a group of what they called the Young Turks--younger Democrats who came into a very conservative Republican legislature. Most of them were under 40. Many of them were veterans of World War II. They moved forward to try to bring about some long needed change in the State. Their experience in the legislature motivated Phil Hoff to run for Governor in 1962. As Senator Leahy indicated, if my memory is correct, he was the first Democrat elected Governor since the Civil War; is that right?

Mr. SANDERS. Mr. President, every now and then there are figures who come along who play a profound and transformative role in the period in which they are living. Phil Hoff is one of those people. We are here to celebrate his 90th birthday and the work he has done in Vermont and around the country and the life he and his wife Joan have lived, both of whom have done so much for the people of the State of Vermont. Phil Hoff was the 73rd Governor of the State of Vermont. He was in many ways the founder of progressive politics in our State. It is now recognized--and we say this proudly, although not everybody necessarily is as proud of it as we are--but Vermont is now one of the more progressive States in the United States of America. We have been a leader for the rights of working people, for the environment, for women's rights, for gay rights, for kids, and we are proud of that, but none of that would have happened--we would not be where we are today-- if it had not been for the work of Phil Hoff, who has Governor of our State and was elected in 1962. I am going to yield to my colleague Senator Leahy now. I have a lot more I wish to say, but let me begin the discussion by saying that we in Vermont are extraordinarily fortunate that one of the great Governors of his time is a real visionary, a man who led the beginning of making profound changes in the State of Vermont. I yield back to the senior Senator from Vermont, Mr. Leahy.

Mr. SANDERS. Mr. President, Senator Leahy talked about the influence Governor Hoff had on the State. Let me give some examples of what he did. Senator Leahy will remember in the early 1960s we had the situation in Vermont where the Vermont State House of Representatives, people were represented by every town. I lived for a while in the town of Stannard, VT, which has maybe 100, 150 people, and they had the same vote in the legislature as Burlington, VT, the largest city in the State, which has 40,000 people. Under Phil Hoff, what we moved to in the State--and with the Supreme Court ruling dealing with proper apportionment--was person, one vote, so the house began to reflect the population locations of the State and not just every town. In addition to that, when Phil Hoff was Governor of the State, he successfully insisted on repealing Vermont's poll tax. Now we think that is ancient history. What the poll tax said is that in order to vote, you have to pay a certain amount of money, which, obviously, is discriminatory to lower income people. That was repealed under Hoff's era as Governor. He understood and his wife understood the importance of education. What Governor Hoff did was he quadrupled State aid to public schools and organized the three State teachers colleges into a new, revitalized State college system that better met the needs of Vermont's students. That system endures to this day. We have a very strong system of State colleges in Vermont, and that began under the Hoff era. Under Governor Hoff's leadership, Vermont's judicial system was modernized. Always a path breaker and an advocate for justice, Phil Hoff led the way to Vermont becoming one of the first States in the country to abolish the death penalty. No aspect of State government was beneath his notice, and he took Vermont forward in many ways, including terminating the outdated ``overseer of the poor'' system. That was something he changed as well. He established the Vermont district court State court system, the Judicial Nominating Board, the Vermont State Housing Authority, and the Vermont Student Assistance Corporation--a program which today plays a very vital role in making sure young people in Vermont can get a college education. What was also--and Senator Leahy knows this better than I--rather extraordinary about Phil Hoff is he understood that positive change could not take place in Vermont unless change was taking place throughout the country. In that area, being the Governor of one of the smallest States in the country, this man showed extraordinary courage, and he said: Do you know what. That war in Vietnam is not good for Vermont, it is not good for America. He was one of the first public officials, as I recall, I say to Senator Leahy, to speak out. That took a whole lot of courage, to speak out against the war in Vietnam. He took it a step further. Here you had Lyndon Johnson at that time--who I think will go down in history, except for that war in Vietnam, as one of our great Presidents--and Phil Hoff said: Do you know what. Maybe we need a change in the White House, and maybe we should be looking at somebody like Bobby Kennedy rather than Lyndon Johnson. But, I say to Senator Leahy, I know he was involved in some of that as a young man.

Mr. SANDERS. For more than 100 years--I think many people don't know this--the Republican Party dominated Vermont politics, controlling both Houses of the legislature and the Governor's office. This is a funny story. Even in the landslide Presidential election of 1936, when FDR--Franklin Delano Roosevelt--won a huge landslide victory, Vermont joined Maine as the only State in the country to vote against Roosevelt and vote for Alfred Landon, and thus came the well- known expression: ``As goes Maine, so goes Vermont.'' What Phil Hoff helped do is lead Vermont out of a one-party State, badly in need of reforms, and brought that State in many significant ways into the second half of the 20th century. I yield back to the senior Senator from Vermont.

Mr. SANDERS. Let me concur with Senator Leahy. We take this opportunity to wish Governor Hoff a very happy 90th birthday. Jane and I see him quite often, and we just bumped into Phil and Joan recently. We look forward to continuing that relationship. The bottom line is, as Senator Leahy said, we are very proud that Vermont is a leader in so many areas in terms of social justice, in terms of environmental sanity, in terms of protecting the needs of ordinary people. That transformation and those efforts did not come about by accident, and certainly one of the great leaders in moving us in that direction was the man we honor today; that is, Philip H. Hoff. We wish him the very, very best in the years to come.

Mr. SANDERS. With that, I yield the floor.

Mr. SANDERS

Mr. SANDERS. I thank very much the Senator from Idaho. Let me wrap it up by making the point that Acting Secretary Gibson made this morning which was a very simple but important one. What he said is we must address the immediate crisis of ending these outrageously long waiting periods that veterans are now experiencing in order to get into the VA. Right now--and I am proud of what he is doing--they are moving very aggressively to get veterans all over this country into private health care when necessary and any other form of health care, to make sure those waiting periods go down. I think they are doing a pretty good job. They have to continue to do that, but we should be mindful that this is going to be a very expensive process. The other point he made, which is equally important, is that long term, if the goal is to end these unacceptable waiting periods, we have to give the VA the staffing and the space and the facilities and the infrastructure they need. He came forward with what I recognize is a very big pricetag. His pricetag was $17.6 billion, so we can get the 10,000 more staff we need, the doctors, the psychiatrists, the primary health care physicians, the mental health counselors we need, get the space we need, because in many facilities around the country the staff can't operate because they don't have adequate space. So what I would say to my colleagues, if we are serious about addressing this very important problem, we will go forward in two ways. No. 1, immediate crisis, let's end those waiting lists. Let's contract out when necessary to private physicians. Long term, it is absolutely imperative that the VA have the infrastructure it needs so we don't have this crisis again 2 years from today. The last point, I reiterate. If we send people off to war--if we make that enormously difficult, painful decision--I hope every Member in this body understands that taking care of veterans is a cost of that war and that we have a moral responsibility to do everything we can with them and for them and their families. Before I yield the floor, I ask unanimous consent to have printed in the Record a memorandum submitted by Acting Secretary Sloan Gibson at our committee hearing earlier today.

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

Mr. SANDERS. Mr. President, I wanted to inform the Members about an important hearing that was held this morning in the Senate Veterans' Committee. I also wish to thank the Members of the Senate who, in the midst of a very partisan environment last month, voted with 93 votes-- overwhelming support--to pass a very significant piece of legislation to help the men and women who put their lives on the line to defend our country--legislation that was written by Senator McCain and myself, and I thank him very much for his help in this effort. One of the important provisions in that legislation was an understanding that the needs of our veterans are a cost of war. They are a cost of war just as much as guns and tanks and planes and missiles are a cost of war. It seems to me to be fairly obvious that if we spend trillions of dollars fighting the wars in Iraq and Afghanistan, it is absolutely appropriate to make sure we have money available on an emergency basis to take care of the men and women who use those guns and tanks and missiles and who put their lives on the line and, in some cases, never come home. So the first point I wish to make is that if we send people to war, we should always understand that a cost of that war is taking care of our veterans. I recall--and I see the chairperson of the Appropriations Committee and she will recall this as well--that when this country went to war in Iraq and after in Afghanistan--and let me be clear, I voted against the war in Iraq--but when we went to war in Iraq and in Afghanistan, the understanding was that this is emergency funding; that our troops, no matter how one voted on the war, needed the equipment to take care of themselves, to protect themselves, and to win the mission. That is exactly where we are today. We want to win this mission. The mission we are involved in now is making sure the men and women who served this country in the military get quality care in a timely manner. That is the mission we have to win now, and that, in my view, is a cost of war. I think there is not widespread awareness of what the cost of war is, and I hope, A, we never get into more wars in the future, but that if we ever do, people understand that any budget for war must include the needs of veterans--not 2 years after the war but 70 years after the war. When some veteran is sitting in some room in an apartment without legs, without arms, without eyesight, that is a cost of war and we don't desert those people--not tomorrow, not 50 years from now, not 70 years from now. Our moral commitment is to make certain we provide for those who defend us. I think there is not sufficient understanding about what the cost of war truly is. I wish to mention just a few facts people should understand. Over 2 million men and women served this country in Afghanistan and in Iraq. Studies are very clear that 20 to 30 percent of those men and women have come home with post-traumatic stress disorder or traumatic brain injury. That is between 400,000 to 500,000 men and women who are coming home with PTSD or TBI. What that translates into is men and women who are struggling every single day. It translates into outrageously high rates of suicide for younger veterans, substance abuse, inability to hold on to a job and earn a living; many of these folks have a difficult time being around people. It translates into divorce. It translates into emotional problems for kids and for other family members. Since fiscal year 2006, the number of veterans receiving specialized mental health treatment has risen from over 927,000 to more than 1.4 million in fiscal year 2013. Today, and every day, approximately 49,000 veterans are receiving outpatient mental health appointments. Let me repeat that. Today, some 49,000 veterans in 50 States in this country are receiving mental health appointments. That is a staggering number. During the last 4 years, VA outpatient mental health visits have increased from $14 million a year to more than $18 million a year. This is just one of the problems facing the veterans community. How do we provide the psychiatrists, the social workers, the psychologists, the counselors we need? It is a huge issue because PTSD and TBI are very tough illnesses. In addition, what we are looking at now--and every Member of the Senate is familiar with this--is outrageously high waiting periods for veterans to get into the VA. Time and time again I hear from veterans in Vermont and I hear from veterans all over the country; I hear from veterans organizations and I read independent surveys which tell me that when veterans get into the VA, the quality of the care they get is good. I just met 2 hours ago with a veterans organization--same thing: Once people get into the system, the quality of care is generally good; the problem is accessing the care. The problem is appointments. I will not read to my colleagues all of the statistics, but trust me the waiting lines all over this country are much too high in many parts of America. There are other people who never even made it to the waiting lines. This has to do with a whole lot of issues that we have discussed. The bottom line is we must address the waiting time issue and make sure that in the very near future, every veteran who is in need of health care gets that health care in a timely manner. Sloan Gibson, who is the Acting Secretary of the VA----

Mr. SANDERS. Could I ask my colleague just for 3 more minutes?

Mr. SANDERS

Mr. SANDERS. I am happy to yield the floor to the Senator from Illinois.

Mr. SANDERS. Madam President, I wanted to say a few words about the conference committee in terms of legislation protecting the health of our veterans. We are working hard on it in the Senate, the House is working hard on it, and our staffs have been meeting. I have been in touch often with Chairman Miller in the House. We had, I thought, a very productive conference committee before we left. As we continue to proceed, if there is anything I have learned since I have been chairman of the Senate Committee on Veterans' Affairs, it is that I think as a people, as a nation, we underestimate the cost of war, and before anyone votes to go to war again I think they should fully appreciate the repercussions of that vote. What going to war means is not--as in the case of Afghanistan and Iraq--losing some 6,700 brave men and women. That is a terrible loss, but I also want people to remember the families, the wives, the kids, the mothers, and the impact that loss has had on their lives and the need for us to protect those wives and those children to make sure they can have the quality of life they are entitled to despite their loss. But it is not only loss of life. We have had in this war a horrendous epidemic of men and women coming home with post-traumatic stress disorder. I am not sure of exactly the number, but it could be as high as 500,000 men and women coming home from war with PTSD and that is a very difficult illness which needs a lot of care and that illness, again, impacts the entire family--wives, kids. It impacts the ability of a worker to go out and get a job to earn an income. That is a cost of war. Needless to say, the cost of war is the many who came home without legs, who came home without arms, who came home without eyesight. The cost of war is a high divorce rate for folks who come home who cannot readjust well into their family life. The cost of war is an extremely high rate of suicides. The cost of war is widows who are now having to rebuild their lives. And on and on it goes. The bottom line is the cost of war is enormous in terms of human suffering and the impact on not only the individual who fought in that war but on the entire family. As I think our colleagues know, several weeks ago Senator McCain and I put together a proposal to deal with the current crisis at the VA, and I am very proud that legislation passed the Senate by a vote of 93 to 3. What are we dealing with? What is the cost of this proposal? This is an expensive proposal because the cost of war is expensive. What a VA audit told us is that more than 57,000 veterans are waiting to be scheduled for medical appointments. These are the folks who are on these waiting lists, some of which were secret, some of which had data manipulated. These are folks who should have been getting into the VA for timely health care but who were not. On top of that, there is an unknown number of veterans who are on no lists because of poor work being done at the VA. They were not on any list. How many there are we don't know, but many of those people need to be seen. So what our legislation does is say we are going to make certain that all of these veterans who are waiting for health care--who have waited far too long for health care--will, in fact, get health care as soon as they possibly can, and they will get that health care either through private physicians, they will get that health care in community health centers, they will get that health care at the Department of Defense military bases, they will get that health care at the Indian Health Service, but they will get that health care in a timely manner, and that is going to be an expensive proposition. We cannot provide health care to tens and tens of thousands of veterans in a short period of time outside of the VA without spending a substantial sum of money. No. 2, long-term, what is clear to me and I think to anybody who has studied the issue is that if we are serious about eliminating these waiting lists and getting people into the VA in a timely manner, we have to make sure that at every facility in this country the VA has the requisite number of doctors, nurses, and other types of personnel they need in order to accommodate the growing numbers of people who are coming into the VA. If we are talking about hiring thousands of doctors in a moment, by the way, where we have a very serious doctor shortage in this country, that is going to be an expensive proposition, as well as hiring the nurses and other personnel and building or leasing the space we need. That is issue No. 2. That is going to be expensive, but long term, if we are serious about keeping our commitment to the men and women who put their lives on the line to defend this country, that is exactly what we have to do. The third area in this legislation which is going to be expensive is we have now for the first time said to veterans that if they are living a distance away from a VA facility, more than 40 miles, they are going to be able to go to a private doctor. That will cost us some money as well.

Mr. SANDERS. The Senator is exactly right. While no one is quite exactly clear how much those two wars will end up costing us, the estimate is between $3 and $6 trillion. The point Senator Durbin made is even those who voted against the war--and I did as well--understood that when we sent men and women off to battle they would have to have all of the resources they needed to do their mission. Equally important, what we are saying now is when they come home wounded in body, wounded in spirit, we need them to have the resources they require to make their lives whole again. That is a moral obligation. I thank the Senator for raising that point. I will yield the floor in a second, but first I will conclude by saying that I want to see this bill passed as soon as possible. We are working as hard as we possibly can, but anyone who magically thinks the only problem facing the VA is more accountability and better management is not correct. We do need better management at the VA, we do need more accountability at the VA, and this legislation will provide that. People who are incompetent and people who are dishonest should be fired. There must be more transparency, and there certainly must be a much clearer chain of command that goes from Washington to regional hospitals and facilities and back up again. At the end of the day, the best management in the world is not going to provide the quality and timely health care veterans need unless we have the doctors, nurses, and other medical personnel, and that is the simple fact. Excellent management, yes; transparency, yes; fire incompetent people, yes; but we also need the doctors and nurses to provide quality and timely care to the veterans of our country. With that, I yield the floor.

Mr. SANDERS. I very much thank the Senator. Let me answer the very last question first, and I will go through the others. I think throughout the history of this country, not only in Iraq and Afghanistan, I think as a people we have underestimated the real cost of war. There was no word called PTSD at the end of World War II, but anyone who thinks that men and women did not come home from war suffering from that ailment would be very mistaken. So the cost of war is real, and it is not just missiles and tanks and guns. If this country means anything, we take care of all of those who serve, to the last day of their lives, when they need that care. I don't have the date in front of me, but I think it was about 3 weeks ago when we passed that legislation by a huge vote. I think there were only 3 people who voted against it. It was a vote of 93 to 3--huge bipartisan support for the bill. But equally important, to answer the important question raised by the Senator from Illinois, there was also an overwhelming understanding that paying for this bill is a cost of war. It has to be emergency funded, and in a strong bipartisan vote the Senate said, yes, that is how we are going to pay for it. In terms of the House bill, the House bill was a reasonable bill, but they did not go into the detail we did in terms of how it will be paid. But the major point I do want to make--I was just going to get to that and I appreciate the Senator from Illinois raising it. This bill is not going to be paid for by cutting education or food stamps. That isn't going to happen. That isn't going to happen, first of all, because it is not going to happen and, second of all, it would be grossly disrespectful to the veterans of this country. The veterans of this country need help. They need help now. This legislation must be passed as soon as possible, and it must be passed in terms of the emergency funding. This is a cost of war. I would ask my friend from Illinois, the whip, can he recall what kind of programs were offset and what kind of taxes were raised to pay for the wars in Iraq and Afghanistan?

Mr. SANDERS

Mr. SANDERS. Mr. President, as we are about to begin the Fourth of July district work period in my State and throughout this country, many people are going to be getting into their automobiles and they are going to be traveling. In general, people who live in rural States such as Vermont don't have the option of getting on a subway. They don't have the option of getting on a bus to get to work. They use their automobile. In Vermont and all across this country, people who are driving have noticed that the price of gasoline at the pump has soared and is today much higher than it used to be. According to the Energy Information Administration, the national average retail price for regular unleaded gasoline is $3.70 a gallon-- the highest price for this time of year since 2008. According to the AAA, drivers in three States have paid over $4 a gallon at the pump for more than a month, and those States are Hawaii, California, and Alaska. In my home State of Vermont, the current average for a gallon of gas is about $3.73. When the price of gasoline goes up, a lot of people get hurt and the economy gets impacted. But mostly it affects working people who have no other option but traveling by car, and many of these workers are making $10, $12, $15 an hour; and many of these workers have seen declines in their wages in recent years. Yet, in order to get to work to make a living, they have to get in the car and they have no choice but to pay soaring gas prices. While gas prices are soaring, people should not be shocked or will not be shocked to know that the big oil companies, which have racked up $1.2 trillion in profits since 2001, are now telling us that the reason gas prices are going up is because of the volatile situation in Iraq. That is why suddenly gas prices have gone up--because of the conflict in Iraq. The American people are sick and tired of hearing from the big oil companies using every excuse they possibly can. If it is snowing, the price of gas goes up. If there is conflict in the Middle East, the price of gas goes up. If it is raining, if it is sunny, if it is somebody's birthday, the price of gas goes up. Interestingly enough, we don't see that same logic when the price of gas should be going down, but it always seems to be going up. Meanwhile, the five biggest oil companies in America--again, not too surprisingly--continue to make huge profits. During the first quarter of this year, ExxonMobil made a profit of $9.1 billion--the first quarter; Shell made $7.3 billion, Chevron made $4.5 billion, and ConocoPhillips made $2.1 billion. The price of gas at the pump soars and the major oil companies make huge profits. Last year, these five major oil companies--ExxonMobil, Shell, Chevron, ConocoPhillips--made $93 billion in profits. ExxonMobil alone made nearly $33 billion in profits in 2013. So in the State of Vermont and all over this country, working people are seeing, in many cases, declines in their wages. Yet they have to get to work. Meanwhile, the price of oil, the price of gas soars, and the oil companies make out like bandits. Here is the interesting point: When I was in high school--and I suspect kids all over the country are still being taught this--we learned about a theory called supply and demand. What supply and demand is about is when there is a lot of supply and limited demand, prices go down. When there is limited supply and a lot of demand, prices go up. Well, guess what. To nobody's surprise, that is not the way it works in the oil industry. Today, there is more supply and less demand for gasoline than there was 5 years ago when the average price of a gallon of gas was just $2.69 a gallon. So let me repeat that. More supply, less demand, and today the price of a gallon of gas is $3.70 a gallon, but 5 years ago it was $2.69 a gallon. Where is the logic of supply and demand? Where is that process? According to the EIA, there has been a 9 million barrel increase in the supply of gasoline over the past 5 years--a 9 million barrel increase. Since 2009, the United States has increased gasoline supplies by 4.3 percent. Supply has gone up. What about demand? According to the EIA, the United States is consuming 96,000 fewer barrels of gasoline than it did in 2009--a 1-percent drop in demand compared to 5 years ago. If the supply and demand theory were true, gasoline prices would be a bit lower--a bit lower--than they were 5 years ago--somewhere perhaps in the neighborhood of $2.69 a gallon. Instead, despite the increase in supply, despite the lowering of demand, the average price for a gallon of gas in the United States has gone up by nearly 38 percent over the last 5 years, from $2.69 a gallon to $3.70 a gallon. Let me repeat. Since 2009 the supply of gasoline has gone up by more than 4 percent and demand for gasoline has gone down by 1 percent. Yet prices at the pump are up by nearly 38 percent. People say: We need more oil, we need more gas. It doesn't matter-- supply up, demand down, prices of gas at the pump soaring. The truth is the high gasoline prices have less to do with supply and demand and more to do with Wall Street speculators driving prices up in the energy futures market. Over a decade ago, speculators only controlled about 30 to 40 percent of the oil futures market. Today, Wall Street speculators control about 80 percent of this market. Let me repeat. Wall Street speculators control about 80 percent of the oil futures market, even though many of them will never use a drop of the oil. People think that when people own oil on the oil futures market, they actually own it because they are going to use it. Maybe it is the airline industry; maybe it is the trucking industry; maybe it is oil fuel dealers. Wrong. The oil futures market is controlled by speculators who never use the end product and whose only goal in life is to drive prices up to make a huge profit, and that is exactly what they do. We, as the elected officials of this country, who are presumably representing working families around America, have a responsibility to do everything we can to make sure the price of gasoline at the pump is based on the fundamentals of supply and demand and not Wall Street greed. That is why I am introducing legislation today to require the Commodity Futures Trading Commission to use all of its authority, including its emergency powers, to eliminate excessive oil speculation. This bill is cosponsored by Senators Levin, Nelson, Blumenthal, McCaskill, Franken, Brown, Cardin, Baldwin, Whitehouse, Markey, Klobuchar, Shaheen, Merkley, and Hirono. Congresswoman Rosa DeLauro is introducing the companion bill in the House. I thank all of these Members for their support. Our legislation, the Energy Markets Emergency Act, is identical to bipartisan legislation that overwhelmingly passed the House of Representatives by a vote of 402 to 19 during a similar crisis in June of 2008. Specifically, our bill directs the CFTC to do the following within 14 days of enactment: No. 1: Immediately curb the role of excessive speculation in any contract market within the jurisdiction and control of the Commodity Futures Trading Commission, on or through which energy futures or swaps are traded. No. 2: Eliminate excessive speculation, price distortion, sudden or unreasonable fluctuations or unwarranted changes in prices or other unlawful activity that is causing major market disturbances that prevent gasoline and oil prices from accurately reflecting the forces of supply and demand. There is now a growing consensus--this is not just the opinion of Bernie Sanders--there is a growing consensus that excessive speculation on the oil futures market is significantly contributing to the high prices the American people are seeing at the pump. ExxonMobil, Goldman Sachs, the IMF, the St. Louis Federal Reserve, the American Trucking Association, Delta Airlines, the Petroleum Marketers Association of America, the New England Fuel Institute, the Consumer Federation of America, and many other organizations have all agreed that excessive oil speculation has significantly increased oil and gas prices. Just a few years ago, Goldman Sachs--perhaps the largest speculator on Wall Street--came out with a report indicating that excessive oil speculation is costing Americans 56 cents a gallon at the pump--56 cents a gallon. I personally think that is a conservative estimate, but it is interesting that it comes from Goldman Sachs itself. The CEO--and what can we say--the CEO of ExxonMobil has testified in the past that he believes excessive speculation has contributed as much as 40 percent to the price of a barrel of oil. So what you are hearing is some of the Wall Street people--in a rare moment of honesty--acknowledging the impact of speculation. You are hearing the head of the largest oil company in America acknowledging the impact of speculation on gas prices. I think we do not need a whole lot of evidence to suggest this is a serious problem. Three years ago my office obtained confidential information about how much Wall Street speculators were trading in the oil futures market on just one day--and that day was June 30, 2008--when the price of oil was over $140 a barrel and gas prices were over $4 a gallon. Here is what some of the biggest oil speculators were doing back then, on just one day of trading: June 30, 2008. This goes on every day. One day: Goldman Sachs bought and sold over 863 million barrels of oil, Morgan Stanley bought and sold over 632 million barrels of oil, Bank of America bought and sold over 112 million barrels of oil, Lehman Brothers--obviously now bankrupt--bought and sold over 300 million barrels of oil, Merrill Lynch--bought by Bank of America--bought and sold over 240 million barrels of oil. The only reason these firms were betting on the price of oil was to speculate and to make money. Goldman Sachs, Bank of America, they do not use oil. Their only function in this process is speculation, driving up prices and making huge profits. The rise in oil and gasoline prices was entirely avoidable. The Dodd- Frank Wall Street Reform and Consumer Protection Act required the CFTC to impose strict limits on the amount of oil that Wall Street speculators could trade in the energy futures market by January 17, 2011--over 3\1/2\ years ago. Unfortunately, the CFTC has been unable to implement position limits due to opposition from Wall Street and a ruling by the DC Circuit Court. This is simply unacceptable. Millions and millions of Americans who are filling up their gas tanks today are disgusted. They know they are being ripped off, and they want us to protect their needs. The time is now to provide the American people relief at the gas pump before the situation gets even worse. I urge my colleagues to cosponsor this legislation.

Mr. SANDERS

Mr. SANDERS. I thank the Chair. (The remarks of Mr. Sanders pertaining to the introduction of S. 2548 are printed in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. SANDERS. I yield the floor.

Mr. SANDERS

Mr. SANDERS. Mr. President, as we are about to begin the Fourth of July district work period in my State and throughout this country, many people are going to be getting into their automobiles and they are going to be traveling. In general, people who live in rural States such as Vermont don't have the option of getting on a subway. They don't have the option of getting on a bus to get to work. They use their automobile. In Vermont and all across this country, people who are driving have noticed that the price of gasoline at the pump has soared and is today much higher than it used to be. According to the Energy Information Administration, the national average retail price for regular unleaded gasoline is $3.70 a gallon-- the highest price for this time of year since 2008. According to the AAA, drivers in three States have paid over $4 a gallon at the pump for more than a month, and those States are Hawaii, California, and Alaska. In my home State of Vermont, the current average for a gallon of gas is about $3.73. When the price of gasoline goes up, a lot of people get hurt and the economy gets impacted. But mostly it affects working people who have no other option but traveling by car, and many of these workers are making $10, $12, $15 an hour; and many of these workers have seen declines in their wages in recent years. Yet, in order to get to work to make a living, they have to get in the car and they have no choice but to pay soaring gas prices. While gas prices are soaring, people should not be shocked or will not be shocked to know that the big oil companies, which have racked up $1.2 trillion in profits since 2001, are now telling us that the reason gas prices are going up is because of the volatile situation in Iraq. That is why suddenly gas prices have gone up--because of the conflict in Iraq. The American people are sick and tired of hearing from the big oil companies using every excuse they possibly can. If it is snowing, the price of gas goes up. If there is conflict in the Middle East, the price of gas goes up. If it is raining, if it is sunny, if it is somebody's birthday, the price of gas goes up. Interestingly enough, we don't see that same logic when the price of gas should be going down, but it always seems to be going up. Meanwhile, the five biggest oil companies in America--again, not too surprisingly--continue to make huge profits. During the first quarter of this year, ExxonMobil made a profit of $9.1 billion--the first quarter; Shell made $7.3 billion, Chevron made $4.5 billion, and ConocoPhillips made $2.1 billion. The price of gas at the pump soars and the major oil companies make huge profits. Last year, these five major oil companies--ExxonMobil, Shell, Chevron, ConocoPhillips--made $93 billion in profits. ExxonMobil alone made nearly $33 billion in profits in 2013. So in the State of Vermont and all over this country, working people are seeing, in many cases, declines in their wages. Yet they have to get to work. Meanwhile, the price of oil, the price of gas soars, and the oil companies make out like bandits. Here is the interesting point: When I was in high school--and I suspect kids all over the country are still being taught this--we learned about a theory called supply and demand. What supply and demand is about is when there is a lot of supply and limited demand, prices go down. When there is limited supply and a lot of demand, prices go up. Well, guess what. To nobody's surprise, that is not the way it works in the oil industry. Today, there is more supply and less demand for gasoline than there was 5 years ago when the average price of a gallon of gas was just $2.69 a gallon. So let me repeat that. More supply, less demand, and today the price of a gallon of gas is $3.70 a gallon, but 5 years ago it was $2.69 a gallon. Where is the logic of supply and demand? Where is that process? According to the EIA, there has been a 9 million barrel increase in the supply of gasoline over the past 5 years--a 9 million barrel increase. Since 2009, the United States has increased gasoline supplies by 4.3 percent. Supply has gone up. What about demand? According to the EIA, the United States is consuming 96,000 fewer barrels of gasoline than it did in 2009--a 1-percent drop in demand compared to 5 years ago. If the supply and demand theory were true, gasoline prices would be a bit lower--a bit lower--than they were 5 years ago--somewhere perhaps in the neighborhood of $2.69 a gallon. Instead, despite the increase in supply, despite the lowering of demand, the average price for a gallon of gas in the United States has gone up by nearly 38 percent over the last 5 years, from $2.69 a gallon to $3.70 a gallon. Let me repeat. Since 2009 the supply of gasoline has gone up by more than 4 percent and demand for gasoline has gone down by 1 percent. Yet prices at the pump are up by nearly 38 percent. People say: We need more oil, we need more gas. It doesn't matter-- supply up, demand down, prices of gas at the pump soaring. The truth is the high gasoline prices have less to do with supply and demand and more to do with Wall Street speculators driving prices up in the energy futures market. Over a decade ago, speculators only controlled about 30 to 40 percent of the oil futures market. Today, Wall Street speculators control about 80 percent of this market. Let me repeat. Wall Street speculators control about 80 percent of the oil futures market, even though many of them will never use a drop of the oil. People think that when people own oil on the oil futures market, they actually own it because they are going to use it. Maybe it is the airline industry; maybe it is the trucking industry; maybe it is oil fuel dealers. Wrong. The oil futures market is controlled by speculators who never use the end product and whose only goal in life is to drive prices up to make a huge profit, and that is exactly what they do. We, as the elected officials of this country, who are presumably representing working families around America, have a responsibility to do everything we can to make sure the price of gasoline at the pump is based on the fundamentals of supply and demand and not Wall Street greed. That is why I am introducing legislation today to require the Commodity Futures Trading Commission to use all of its authority, including its emergency powers, to eliminate excessive oil speculation. This bill is cosponsored by Senators Levin, Nelson, Blumenthal, McCaskill, Franken, Brown, Cardin, Baldwin, Whitehouse, Markey, Klobuchar, Shaheen, Merkley, and Hirono. Congresswoman Rosa DeLauro is introducing the companion bill in the House. I thank all of these Members for their support. Our legislation, the Energy Markets Emergency Act, is identical to bipartisan legislation that overwhelmingly passed the House of Representatives by a vote of 402 to 19 during a similar crisis in June of 2008. Specifically, our bill directs the CFTC to do the following within 14 days of enactment: No. 1: Immediately curb the role of excessive speculation in any contract market within the jurisdiction and control of the Commodity Futures Trading Commission, on or through which energy futures or swaps are traded. No. 2: Eliminate excessive speculation, price distortion, sudden or unreasonable fluctuations or unwarranted changes in prices or other unlawful activity that is causing major market disturbances that prevent gasoline and oil prices from accurately reflecting the forces of supply and demand. There is now a growing consensus--this is not just the opinion of Bernie Sanders--there is a growing consensus that excessive speculation on the oil futures market is significantly contributing to the high prices the American people are seeing at the pump. ExxonMobil, Goldman Sachs, the IMF, the St. Louis Federal Reserve, the American Trucking Association, Delta Airlines, the Petroleum Marketers Association of America, the New England Fuel Institute, the Consumer Federation of America, and many other organizations have all agreed that excessive oil speculation has significantly increased oil and gas prices. Just a few years ago, Goldman Sachs--perhaps the largest speculator on Wall Street--came out with a report indicating that excessive oil speculation is costing Americans 56 cents a gallon at the pump--56 cents a gallon. I personally think that is a conservative estimate, but it is interesting that it comes from Goldman Sachs itself. The CEO--and what can we say--the CEO of ExxonMobil has testified in the past that he believes excessive speculation has contributed as much as 40 percent to the price of a barrel of oil. So what you are hearing is some of the Wall Street people--in a rare moment of honesty--acknowledging the impact of speculation. You are hearing the head of the largest oil company in America acknowledging the impact of speculation on gas prices. I think we do not need a whole lot of evidence to suggest this is a serious problem. Three years ago my office obtained confidential information about how much Wall Street speculators were trading in the oil futures market on just one day--and that day was June 30, 2008--when the price of oil was over $140 a barrel and gas prices were over $4 a gallon. Here is what some of the biggest oil speculators were doing back then, on just one day of trading: June 30, 2008. This goes on every day. One day: Goldman Sachs bought and sold over 863 million barrels of oil, Morgan Stanley bought and sold over 632 million barrels of oil, Bank of America bought and sold over 112 million barrels of oil, Lehman Brothers--obviously now bankrupt--bought and sold over 300 million barrels of oil, Merrill Lynch--bought by Bank of America--bought and sold over 240 million barrels of oil. The only reason these firms were betting on the price of oil was to speculate and to make money. Goldman Sachs, Bank of America, they do not use oil. Their only function in this process is speculation, driving up prices and making huge profits. The rise in oil and gasoline prices was entirely avoidable. The Dodd- Frank Wall Street Reform and Consumer Protection Act required the CFTC to impose strict limits on the amount of oil that Wall Street speculators could trade in the energy futures market by January 17, 2011--over 3\1/2\ years ago. Unfortunately, the CFTC has been unable to implement position limits due to opposition from Wall Street and a ruling by the DC Circuit Court. This is simply unacceptable. Millions and millions of Americans who are filling up their gas tanks today are disgusted. They know they are being ripped off, and they want us to protect their needs. The time is now to provide the American people relief at the gas pump before the situation gets even worse. I urge my colleagues to cosponsor this legislation.

Mr. SANDERS

Mr. SANDERS. Madam President, as chairman of the Senate Veterans' Affairs Committee, I would hope that every American understands that the cost of war does not end when the last shots are fired or when the last missiles are launched. The cost of war continues until the last veteran receives the care and benefits he or she has earned on the battlefield. War is an incredibly expensive proposition in terms of human life, human suffering, and in financial terms. In my very strong view, if we are not prepared to take care of those men and women who went to war, then we should not send them to war in the first place. Taking care of veterans is a cost of war, period. In terms of Iraq and Afghanistan, the human cost of those wars is almost 7,000 dead. The cost of war is 530,000 veterans seeking care at the VA in 2013 for post-traumatic stress disorder, not to mention those struggling with traumatic brain injury. The cost of war is too many servicemembers coming home with missing arms and legs, lost eyesight, or lost hearing. The cost of war includes veterans each day dying by suicide, high rates of divorce, wives trying to rebuild their lives after losing their husbands, kids growing up in one-parent homes, and a too high rate of unemployment for returning servicemembers. Those are some of the real costs of war that this Congress cannot ignore. Several weeks ago, Senator McCain and I hammered out an agreement which I think goes a significant way to address many of the serious problems facing the VA. I am very proud that the Sanders-McCain bill passed the Senate with overwhelming bipartisan support, with a vote of 93 to 3. In terms of funding, very importantly, by a vote of 75 to 19, an overwhelming vote, the Senate made it crystal clear that the current crisis in the VA, the crisis facing veterans who are not getting health care in a timely manner, is an emergency and should be paid for through emergency funding. I am very proud that in a bipartisan way the Senate made that important vote. In the last 4 years we have seen a significant increase in the number of veterans utilizing VA health care. In addition, many of our other veterans from World War II, Korea, and Vietnam require a greater amount of care as they age. Further, a recent VA audit revealed that more than 57,000 veterans are on too-long waiting lists in order to be scheduled for medical appointments. In addition to that, there are many other veterans who were never put on a list in the first place, which is what this whole scandal is largely about. Clearly, these waiting lists and veterans not getting care in a timely manner are unacceptable and must be dealt with immediately, not 6 months from now, not a year from now, not in a great debate about national priorities. This is a crisis which must be dealt with now. I could not agree with Senator John McCain more when he said on the Senate floor during this debate: If there is a definition of emergency, I would say that this legislation fits that. It is an emergency. It is an emergency what is happening to our veterans and the men and women who have served this country. We need to pass this legislation and get it to conference with the House as soon as possible. Senator McCain is right. I concur with what he said. We need to get this legislation moving as soon as possible and get it to the President's desk. Veterans in this country must get quality care and they must get that health care in a timely manner. We need to provide the funding the VA needs to accomplish that goal and do it as quickly as we can. The simple truth is that the VA needs more doctors, the VA needs more nurses, it needs more mental health providers, and in certain parts of this country more space for a growing patient population. That is the reality. Does the Veterans' Administration need better management? You bet it does. Does it need to be more efficient, more accountable? Absolutely. But at the end of the day, if you do not have the doctors and the nurses and the medical staff you need, there will continue to be waiting lines unacceptably long and veterans will not get the care they need. I received, as did the chairman of the House Veterans' Affairs Committee, a letter on June 17 which was signed by virtually every major veterans organization. That is the American Legion, the DAV, the VFW, the Paralyzed Veterans of America, the Vietnam Veterans of America, the Iraq and Afghanistan Veterans, and many other organizations. They made a number of very important points in their letter talking about the kind of legislation we need to pass. I want to quote from one section of their letter, which they entitled ``Protect and Preserve the VA Health Care System.'' Any legislative, regulatory or administrative changes designed to respond to the VA health access crisis, whether temporary or permanent, must protect, preserve and strengthen the VA health care system so that it remains capable of providing a full continuum of high-quality, timely health care to all enrolled veterans . . . Then the letter continues: Unless the legislation simultaneously sets VA on a path to intelligently strengthen health care delivery, expand access and capacity, reallocate resources and ensure that overall VA funding matches its mission, the current problems confronting VA and veterans will inevitably recur. In other words, what they are saying is that unless we strengthen the VA, give them the staffing and the space they need, this problem of waiting periods of time will continue. In order to address the long waiting periods, the Senate legislation says to veterans around the country that if you cannot get into a VA facility in a timely manner, you will be able to get the care you need outside of the VA. That means access to private doctors, community health centers, or Department of Defense or Indian Health Service facilities. Furthermore, what the bill says is to veterans who live 40 miles or more from a VA facility, that if they choose, they also have the option of seeking care outside of the VA. Just as the letter from the veterans service organizations articulated, it is critical to address the current waiting period crisis. But we also have to make sure that that crisis does not continue to occur. We do that by providing the VA the tools it needs to ensure sufficient capacity for veterans seeking care at VA medical facilities. Clearly, no medical program can work unless we have the necessary medical staff. Today, the VA has thousands of vacancies for health care providers. These vacancies, along with an untold shortage of health care providers to meet the demands of veterans who want to get VA care, has a direct impact on the ability to get veterans in the door for appointments. To fill these positions, the Senate bill provides for the hiring of VA doctors and nurses, and it does so in an expedited fashion by ensuring VA's hiring efforts are not hamstrung by Federal bureaucracy. During the discussion of VA health care, let us not forget that today alone some 230,000 veterans will walk in the doors of VA facilities for health care--230,000 veterans today, 6.5 million veterans in a year. While it is absolutely true that not every veteran is satisfied by the care he or she is getting, the overwhelming majority--well over 90 percent of them--believe they receive high quality care. Over and over, I hear from Vermont veterans and veterans across the country who say that once they get into the system the care is good. That is just not my view, it is the view of virtually all of the major veterans organizations and a number of independent studies that have compared VA health care with that in the private sector. We owe it to these veterans, to our veterans, to fix the current problems and bolster the system to ensure that quality care is available in the VA for years and decades to come. I have heard a lot of criticism of the VA. Much of that criticism is valid. But when we talk about VA health care, we must put it in the context of health care in the United States of America. Does anyone seriously believe the VA is the only health care institution in America that has problems? It is absolutely the case that not everybody outside of the VA gets timely, quality, affordable health care. That is just not the reality. Today some 40 million Americans have no health insurance. According to a Harvard study of a few years ago, 45,000 Americans die each year because they do not get to the doctor when they should. That is outside of the VA. But it is more than that. Let me read you a few headlines from the last couple of weeks. I make this point not to argue the whole health care debate again but to say that anyone who thinks it is only the VA that has health care problems does not understand what is happening with health care in America. Here is a quote from a few weeks ago. A report released Monday by a respected think tank-- That is the Commonwealth Fund. --ranks the United States dead last in the quality of its health care system when compared with ten other Western industrialized nations. Then the report further tells us that the United States has maintained this dubious distinction while spending far more per capita on health care than any other country. We are spending far more on health care than any other country. Let me read you another headline published September 20, 2013 by FierceHealthCare. ``Hospital Medical Errors Now the Third Leading Cause of Death in US.'' Medical errors leading to patient death are much higher than previously thought and may be as high as 400,000 deaths a year, according to a new study in the Journal of Patient Safety. I mention all of this to make clear that the VA, of course, has its problems. Our job is to strengthen the VA, to provide better accountability, to make sure that incompetent and dishonest people are not working in the VA. But we also have to make sure the VA has the doctors, the nurses, and the other health care providers it needs in order to provide the quality of care our veterans deserve. The last point I want to make. I hope very much the House will agree with the Senate that we are in an emergency. It is absolutely imperative that we move as quickly as possible to get the funding we need so that all veterans enrolled in the VA health care system get quality care in a timely manner. I hope very much that we don't once again have a major debate about whether we are going to cut food stamps or education or roads and bridges in order to fund the Veterans' Administration. When this Congress voted to go to war in Iraq and Afghanistan, it said that it was an emergency. Some of us disagreed with that, and I don't want to debate the Iraq war again, but when Congress said it is an emergency that we go to war, well, if it is an emergency that we go to war, it is more of an emergency that we take care of the men and women who fought in those wars. If you don't believe that is the case, don't send Americans off to war. Taking care of veterans is a cost of war. I hope very much that we don't go back to the same old, same old of having a debate where some people say: Well, if you want to fund VA health care, you are going to have to cut education or cut Medicaid or cut Medicare or cut some other program. That is not the issue. This is an emergency. Our veterans have put their lives on the line. Now is the time for us to defend them, and we have to get this legislation moving. With that, I yield the floor.

Mr. SANDERS

Mr. SANDERS. Madam President, what the recent crisis at the Veterans' Administration has taught us is that the cost of war does not end when the last shots are fired and the last missiles are launched. The cost of war continues until the last veteran receives the care and benefits that he or she has earned on the battlefield. In other words, the cost of war is very expensive. It is expensive in terms of human life, in terms of human suffering, and in terms of financial commitment. The cost of war in Iraq and Afghanistan alone is almost 7,000 dead. The cost of war is some 200,000 men and women coming home from those wars with post-traumatic stress disorder or traumatic brain injury. The cost of war from Iraq and Afghanistan is that many of our veterans have come home without arms or legs or eyesight or without their hearing. The cost of war is tragic suicides taking place all over this country from people who have returned from war. The cost of war is veterans coming home unable to find jobs and get their feet back on the ground financially. The cost of war is high divorce rates and the impact that family stress has on kids. The cost of war is widows suddenly having to start their life anew without the person they married at their side. Two weeks ago Senator McCain and I hammered together a proposal to deal with the current crisis at the VA, and I thank him very much for understanding the need to move forward expeditiously. Last Wednesday this legislation passed the Senate by a vote of 93 to 3, and I thank all of the Members in both political parties for voting for this bill. I thank them for understanding that we need to continue moving forward on this legislation as quickly as possible and in a nonpartisan way. A recent VA audit revealed that more than 57,000 veterans are waiting to be scheduled for medical appointments. They are in facilities where the waiting lists are much too long. That, to my mind, is clearly an emergency situation. I thank all of those Senators who not only voted to pass this bill but, perhaps more importantly, voted to pay for this bill through emergency funding. I could not agree more with Senator McCain when he said: If there is a definition of emergency, I would say that this legislation fits that. It is an emergency. It is an emergency what is happening to our veterans and the men and women who have served this country. And we need to pass this legislation and get it in conference with the House as soon as possible. I fully agree with Senator McCain's sentiment. Madam President, 93 Senators--in a strong bipartisan showing--agreed with Senator McCain and me that this is an emergency, that veterans must get the quality health care they need, and they must get it in a timely manner. We need to provide the funding the VA needs and do it in an expeditious way. Needless to say, the bill we passed in the Senate is a compromise. It is not the bill I know Senator McCain would have written alone, and it is surely not the bill I would have written if I could have had the power to write it alone. It is a compromise that was hammered out in good faith, which is something we need to see more of in this body. What this bill does is address the immediate crisis facing the VA of long waiting periods and makes certain that as soon as possible, the veterans of our country get the high-quality care they need and they get it in a timely fashion. That is what our veterans deserve. I will briefly touch on some of the major provisions in the bill. This bill allows for 26 major medical facility leases, which means improved and expanded care for veterans in 17 States and Puerto Rico. There has been some disagreement about a 27th facility located in Oklahoma. That facility was in the original bill I introduced, and I supported its inclusion in final passage. This bill also provides for the expedited hiring of VA doctors and nurses and $500 million targeted to hire those providers with unobligated funds. No medical program can provide quality care in a timely manner if those programs do not have an adequate number of doctors, nurses, and other medical providers. This bill will provide an opportunity for the VA to immediately increase capacity within their system. It will provide an expedited hiring authority to allow VA to quickly hire doctors and nurses, which is not the case right now. One of the problems with the VA is they have a very complicated process. It takes a whole lot of time, and they often lose their applicants because it takes such a long period of time. We need to change that, and this bill does that. Right now there are 741 vacancy announcements for physician positions at VA on USAJOBS. My understanding is that is a flaw. In fact, the real number of physicians needed is significantly greater than that. In Phoenix alone there have been estimates that up to 500 new providers in that one facility alone--and those are doctors, nurses, and other health care providers--are needed if the veterans in Phoenix are going to have timely care. Further, what our legislation also does is say to veterans around the country that if they cannot get into a VA facility in a timely manner, they will be able to get the care they need outside of the VA. In my view, what we need to do is hire those doctors, nurses, and supporting staff so veterans who come to the VA can get timely care there, but if they cannot get to a VA facility, this legislation is very clear in stating that they can go to private doctors, community health centers, Department of Defense bases or Indian health care facilities. The goal is to give veterans a wide option to access care in a timely manner through providers in their communities. If the VA is unable to accommodate those veterans, they are going to go outside of the VA and get timely health care, and that is a very important provision in this bill. This bill also says veterans who live 40 miles or more from a VA facility--if they choose--also have the option of seeking care outside of the VA. For those veterans living in very rural areas--and I have talked to one Senator who indicated that in some cases a veteran has to travel hundreds and hundreds of miles to get VA health care--this provision will also be very important. The bill also addresses a major crisis we have seen in the military; that is, the tragedy and the outrage of sexual assault. Our bill will significantly increase VA services for those veterans who experienced sexual assault in the military. This bill also deals with an issue--where there is widespread support across partisan lines--instate tuition for all veterans at public colleges and universities. This bill also importantly provides that surviving spouses--mostly wives who have lost their husbands in battle--will also be eligible for the post-9/11 GI bill, and that is exactly the right thing to do. This bill also establishes commissions to provide help to give the VA in terms of improving schedule capabilities and capital planning. These are areas, frankly, where the VA has not been strong. They can use private sector and expert help so they can improve their scheduling capabilities and their ability to do capital planning. Finally, and importantly, this bill gives the Secretary the authority to immediately fire incompetent employees or those who have falsified or manipulated data in terms of waiting periods. All of us have been outraged that people have intentionally manipulated data to make it appear that veterans have been getting timely care when that was not the case. Our bill gives the Secretary the ability to fire those employees and other incompetent employees and it also provides due process. I think that is important because I do not want to see the VA politicized. I don't want to see a President coming into office with a new Secretary firing 300 or 400 top-level supervisors. We do not want to see the VA politicized. We want the best people regardless of their political views. The House of Representatives passed legislation last week which covers a lot of the same ground the Sanders-McCain bill covers, and I am very confident that in working with chairman Jeff Miller and ranking member Mike Michaud, we can bridge the differences and send the President a bill he can sign in the very near future. I think that is what the American people want. That is what Members of Congress want. We do not want this to drag on and on and on. We want to get this bill done quickly. Finally, I did want to say a word to the 300,000 employees who work at the VA. These last several months have been a tough time for many of them. The truth is the overwhelming majority of the people who work at the VA are hard-working, honest, and serious people. In fact, many of them are veterans themselves. I know many others who work at the VA look at what they do not as a job--a 9-to-5 job--but they look at it as a mission. They feel very seriously that our veterans have to get the best health care possible, and they are doing their best to make that happen. I thank them very much for that. Over and over, I hear from my State of Vermont and from across the country that once veterans get into the VA health care system, the care is good. That is not just my view; it is the view of virtually all of the major veterans organizations and independent studies that compare VA health care with care in the private sector. In the State of Vermont some 98 percent of veterans get appointments into the system within 30 days. That is good, but it needs to be better in Vermont and throughout this country. The goal must be the highest quality care possible and getting people their appointments in a timely manner. Let me read, interestingly enough, a poll that just came out from Gallup today. It was published today, and it was commissioned by MarketWatch from the Wall Street Journal. The interesting paragraph here--they polled some 42,000-plus Americans regarding their satisfaction with health care in America. Let me quote what the article says: Despite recent troubles with veterans not having access to prompt medical appointments, current and former military personnel are the most satisfied with their health care, as 77% expressed contentment. That was the highest satisfaction rate among those broken out by method of coverage. Veterans, obviously, get their health care in other ways--not just through the VA--but it is important to recognize that for many, many veterans the health care they are getting is good, and they appreciate that. Let me conclude by saying our job right now--and I think the American people are with us on this virtually 100 percent--is to make sure those men and women who have put their lives on the line to defend us--they are now asking us to defend them, to make sure they get the health care and the benefits to which they are entitled. My goal is to see that we move this legislation as quickly as possible. I hope by tomorrow we will have named conferees to the conference committee. My hope is we can get this legislation on to the President's desk as soon as we possibly can. It is one thing to give heartfelt speeches about how much we love and respect veterans; it is another to act, and now is the time for action. The Senate and House committee staffs have already begun preliminary discussions. My understanding is the House conferees will be named tomorrow. I believe we will do the same here in the Senate. My job and what I intend to work on as hard as I can is to make sure we pass strong legislation as soon as we possibly can and have the President sign that legislation. With that, I suggest the absence of a quorum.

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