Bernie Sanders

Mr. SANDERS

Mr. SANDERS. Madam President, I support the nomination of Charlotte Burrows to be a Member of the Equal Employment Opportunity Commission, EEOC. Charlotte Burrows has been a member of the EEOC since 2015. She was first confirmed by the Senate by a vote of 93-2. When she was renominated in 2019, the Senate confirmed her by voice vote. I look forward to her being confirmed a third time. Charlotte Burrows is dedicated to ensuring that the EEOC plays a critical role in addressing systemic discrimination and advancing equal opportunity. Her priorities include advancing pay equity, preventing unlawful retaliation and harassment, addressing the use of artificial intelligence and other tech tools in employment decisions, and protecting vulnerable workers, including people with disabilities, older workers, temporary workers, and low-wage workers. During her tenure as Chair, Ms. Burrows has helped rebuild the EEOC and its capacity to enforce Federal antidiscrimination laws--restoring staffing levels to meet the public demand for agency services. Under Ms. Burrows' leadership, the EEOC has secured more than $500 million in monetary relief for some 38,000 victims of employment discrimination, and the EEOC has filed over 140 employment discrimination lawsuits in fiscal year 2023, a 50-percent increase over fiscal year 2022. Chair Burrows is committed to ensuring that workers are aware of their rights and employers are aware of their responsibilities. To help accomplish this goal, in fiscal year 2022, EEOC conducted over 3,300 outreach and training events and provided more than 225,000 people nationwide with information about their rights and responsibilities in the workplace. In order to reach more vulnerable workers, the EEOC conducted 1,000 outreach events for vulnerable workers that reached nearly 80,000 individuals. Often, these events were in partnership with local organizations that know these vulnerable and underserved communities the best. During her time as Chair, she has overseen the implementation of the Pregnant Worker's Fairness Act, including advancing a bipartisan proposed rule to implement this important and much-needed law. She has also advanced a much-needed proposal to update harassment guidance and issued technical assistance on practices to prevent harassment in the Federal workplace. She has updated EEOC resources related to individuals with visual disabilities and employment protections for Americans with disabilities. Further, she launched the Artificial Intelligence and Algorithmic Fairness Initiative in 2021 to ensure that these systems are used in ways that reflect values of fairness and equality. The main goal of the Chair's initiative is to assist applicants, workers, employers, and vendors to understand how Federal equal employment opportunity laws apply to these new technologies. Under her leadership, the EEOC is working to address potentially harmful uses of this technology in the workforce. Chair Burrows' dedication to improving the lives of working families and making sure they receive the wages and benefits they deserve make her the right person to lead this agency. I thank her for her service, and I strongly support her nomination to continue as Chair of the EEOC.

Mr. SANDERS

Mr. SANDERS. Mr. President, the American people understand--whether they are Democrats, Republicans, or Independents--that our healthcare system is broken; it is dysfunctional; it is failing. We spend almost twice as much per person on healthcare--an unsustainable $13,000 for every man, woman, and child--than any other country on Earth, and yet the results of all of that spending are abysmal. While the insurance companies and the drug companies make hundreds of billions of dollars in profit, we have 85 million Americans who are uninsured or underinsured and over 60,000 people who die every single year because they can't get to a doctor when they need to. In this country, despite our huge expenditures, we don't have enough doctors, nurses, dentists, pharmacists, or mental health specialists; and our life expectancy is far lower than in most other countries, especially for working class and lower income Americans. In my view-- and I think it is the view of most Americans--healthcare is a human right, not a privilege, and we need major reforms to our current system so that every man, woman, and child in this country gets the quality healthcare they need regardless of their financial status. The responsibility for reforming our broken healthcare system rests with the administration, and it rests with many Agencies of government, including the HHS; the CMS; the FDA; and the National Institutes of Health, the NIH, which plays a very important role in the development of new prescription drugs. While the 10 largest drug companies made over $112 billion in profits last year and while they pay their CEOs exorbitant compensation packages, 1 out of 4 Americans cannot afford to pay for the medicine they need, and thousands of families face financial ruin as they pay outrageously high prices for the prescription drugs that keep them alive. Let's think about that for just 1 second. Millions of people in this country, every year, get sick. They go to the doctor, and the doctor writes out a prescription. Yet, because of the exorbitant price of prescription drugs in America, one out of four of those people cannot afford to fill that prescription. So what happens to those people? Well, they get sicker. Maybe they end up in an emergency room. Maybe they end up in a hospital. Maybe they die. How crazy is it that, in the richest country in the history of the world, 25 percent of our people cannot afford to fill the prescriptions that their doctors prescribe? But it is not just the high cost of prescription drugs that impacts individuals. In the largest hospital in my State, the State of Vermont--and I don't think it is terribly different elsewhere--the high cost of prescription drugs accounts for 20 percent of the overall budget of that hospital, and that drives insurance policies up. What we pay in the hospital impacts greatly the prices we pay for insurance. In other words, the outrageously high cost of prescription drugs in America is a crisis situation that must be addressed. It impacts everybody. Adding insult to injury, not only has the Federal Government not effectively regulated the price of prescription drugs, but the taxpayers of this country have, over the years, provided hundreds of billions of dollars in research and development into new prescription drugs that have provided enormous financial benefits to some of the most profitable drug companies in America. For example, in America today, the median cost of new cancer drugs has gone up by more than 300 percent over the past decade even though 85 percent of the initial foundational cancer research is funded by U.S. taxpayers. In June, the HELP Committee, which I chair, released a report that found that the average price of new treatments that NIH scientists helped to develop over the past 20 years is over $111,000. In other words, we are spending a fortune in developing new drugs, but our people cannot afford the treatments that they pay for. In virtually every case, American taxpayers are paying far more than people in other countries for the exact same medicine that the NIH helped to develop. Now, that may make sense to somebody, but it does not make sense to me. Here are just a few examples from the report: Astellas and Pfizer charge Americans with prostate cancer over $165,000 for Xtandi while the exact same drug can be purchased in Japan for just $20,000. Guess who developed that drug: American taxpayers. Johnson & Johnson charges Americans with HIV $56,000 for Symtuza while the exact same treatment can be purchased in the UK for just $10,000. Guess who developed that treatment: American taxpayers. Millennium Pharmaceuticals charges Americans with cancer $54,000 for Velcade while the exact same drug can be purchased in France for just $11,000. Guess who did the research and paid for that drug: the NIH and American taxpayers. In other words, here is the insane situation: The American taxpayers fund the research for these drugs, but they can't afford the product that they helped create. Does anybody really think that makes sense? If American taxpayers help develop a drug, we should be paying the lowest price in the world for that product, not the highest. That has got to change. No prescription drug, no matter how effective and lifesaving it may be, is worth anything to the patient who cannot afford it. In my view, at this crisis moment for American healthcare, we need an NIH Director who is prepared to take on the greed of the pharmaceutical industry and use every tool at their disposal to substantially lower the extraordinarily high cost of medicine in this country. The 1,800 well-paid lobbyists from the pharmaceutical industry here in DC--it is almost 4 lobbyists for every Member of Congress--may not like it, but that is precisely what the American people want, and it is what they need. The status quo is not working. We need fundamental changes in the way that the NIH addresses the crisis of high prescription drug costs. Dr. Monica Bertagnolli is an intelligent and caring person, but she has not convinced me that she is prepared to take on the greed and power of the drug companies and the healthcare industry in general nor is she prepared, in my view, to fight for the transformative changes the NIH needs at this critical moment. That is why I will be voting no on her confirmation. With that, I yield the floor.

Mr. SANDERS

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

Mr. SANDERS

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

Mr. SANDERS. Mr. President, the situation in Gaza today is a disaster. Congress must take action. The administration must take action. The world must take action. Today, 3 weeks after Hamas's barbaric attack against civilians in Israel, which began this war, many hundreds of thousands of innocent men, women, and children in Gaza are on the brink. Over the past 3 weeks, it is estimated that some 8,000 people in Gaza have been killed in bombings, including more than 3,000 children, and far more have been wounded. More than a million people in Gaza have been displaced from their homes, and some 670,000 are sheltering in U.N. installations, where they are down to 1 liter of water per person per day. They lack sufficient food, water, medical supplies, or fuel. The hospitals and medical facilities there are in nightmarish conditions, with hundreds of babies in incubators and patients on life support at risk of death should the generators that sustain them run out of fuel. Corridors are lined with injured and displaced people, and overwhelmed doctors must turn patients away or operate without anesthesia or antibiotics. The humanitarian crisis is dire and getting worse by the minute. There must be a humanitarian pause now so that sufficient supplies-- food, water, medicine, fuel--can reach the people of Gaza. If not, thousands more will die needlessly. We cannot allow that to happen. A stop to the bombing is critical to save innocent lives and secure the safe return of hostages. Let us never forget the lives of all children--all people--are sacred, whether they are Palestinian children, Israeli children, or American children, and we must do everything we can to protect them. But if we are going to make any real progress in addressing this never- ending conflict between Israel and Hamas--there have been five wars in the last 15 years--we need to understand somewhat as to how we got to where we are today. If peace is to come to that troubled region and if the Palestinian people are ever going to be able to enjoy lives of security and dignity, there must be a vision of where we go in the future. So, let us be clear, the living conditions in Gaza before October 7 were horrific and inhumane, and that is before Hamas ignited the latest war. Before this conflict, in Gaza, nearly 80 percent of people there lived in poverty, and two-thirds were reliant on humanitarian assistance. Almost half the population and over 70 percent of young people were unemployed in Gaza. What kind of life could they look forward to? Electricity there was intermittent, with 11- to 12-hour blackouts every day. Water and sanitation systems were inadequate, and there were constant shortages of all basic necessities. Gaza was mostly cut off from the world, with Israel and Egypt severely limiting the number of people and types of goods that could go in or out. In fact, many observers described Gaza as ``an open-air prison''--and all of that is before October 7. If we are serious about bringing freedom and dignity to the Palestinian people, that is a situation that can never be allowed to be returned to. The Palestinian people are entitled to much more than that. In Gaza, Hamas, an authoritarian terrorist organization, ruled by force, stockpiling arms and war materiel, taxing the desperately poor population, and stealing resources to build tunnels and rockets. Make no mistake about it, Hamas is a terrorist organization bent on the destruction of Israel, and long before this horrific attack, they had killed countless innocent people, including Americans. They advance a fundamentalist ideology which treats women as inferior, second-class citizens and which threatens to kill people who are gay. Hamas is an authoritarian nightmare, repressing dissent and stealing from Gazans not just many materials of life but the dream of a better future. And that was the situation before October 7. And what was going on in Israel before Hamas's terrorist attack? What was going on there? That country had the most rightwing government in its history, a Cabinet that included outright racist Ministers who consistently dehumanized the Palestinian population. Benjamin Netanyahu, the Prime Minister, was under indictment for a litany of corruption charges, and many believe that Israel's intelligence--or lack of intelligence--on October 7 had everything to do with his government's preoccupation with his political problems. Before the war, this rightwing Israeli Government had systematically undermined the prospects of peace. Netanyahu and his extreme partners in the Cabinet had worked to marginalize Palestinian voices committed to peace, pursued settlement policies designed to foreclose the possibility of a two-state solution, stymied economic development in Palestinian areas, and passed laws that entrenched systemic inequality between Jewish and Palestinian citizens of Israel. This last year saw record Israeli settlement growth in the West Bank, where more than 700,000 Israelis now live in areas the United Nations and United States agree are occupied territories. Despite that, the Israeli Government authorized thousands of new homes for settlers and opened up new areas to construction, while bulldozing thousands of Palestinian homes and schools and further restricting Palestinian movement. Legal experts agree, these policies constituted nothing less than illegal annexation. All of these policies and more greatly increased tension in the West Bank. Before October 7, 179 Palestinians had been killed in 2023--179 Palestinians in the West Bank--which made it the deadliest year in two decades. Since October 7, 121 more Palestinians have been killed in the West Bank, including some by settlers. These tensions were part of why so much of the IDF, the Israel Defense Forces, was deployed in the West Bank rather than the border with Gaza. And then came October 7 and Hamas's atrocities that began this latest and horrific war. The Hamas attack was unspeakable. Over 1,300 innocent men, women, and children in Israel were killed; over 200 Israelis and Americans taken hostage, including young children and grandparents. Young people were gunned down in cold blood at a music festival, babies and older people brutally murdered in their homes. And let's remember that Hamas did not primarily target the military-- no. They intentionally targeted civilians. Their goal was to kill civilians. Their attack was designed to provoke a response, and in that they succeeded. Many Israelis are now understandably furious, and they want to strike back forcefully. I think we can all understand that. But rage and revenge do not make useful policy. And here in the United States, after the attack on 9/11 in this country, we acted with rage and revenge, and I think many people now understand that that was a horrific mistake. Killing innocent Palestinian women and children in Gaza will not bring back to life the innocent Israeli women and children who have been killed by Hamas. Like any other country, Israel has the right to defend itself and destroy Hamas terrorism, but it does not have the right to kill thousands of innocent men, women, and children in Gaza. Israel does not have the right to endanger the lives of millions of Palestinians--half of whom are children--by shutting off water, food, fuel, and electricity. That type of action against a helpless and impoverished population is morally unacceptable and in violation of international law. Israel does not have the right to bomb an entire neighborhood to target one Hamas leader or installation, but that is what the Israeli Government is doing. One need only look at the satellite imagery and photography of Gaza to see that this is not a carefully calibrated campaign. These are not surgical strikes. Yesterday, Israel struck the densely populated Jabalia refugee camp and killed a Hamas commander, but they also killed some 50 other people and injured hundreds more, although the exact toll is not yet known. That was actually the fourth airstrike on that community. An October 9 airstrike killed 60, an October 19 airstrike killed 18, and an October 22 airstrike killed 30, according to outside researchers. UNRWA reported yesterday that their head of security--that is the United Nations Relief Agency--their head of security was killed, along with his wife and eight children. In total, 67 United Nations Relief Agency workers have been killed, and 44 United Nations facilities have been damaged since October 7. The current Israeli strategy must end. Israel must begin the process of restoring water and electrical services to areas where they are still operable. The international community must also rush generators and solar capacity to Gazan medical facilities to address acute needs and reduce Israeli fears of diversion to Hamas. Israel will not stop going after Hamas, but it must do it in a very, very different way, and additional pauses will be needed. Let me conclude by saying that Israel must also begin the process of laying out a political strategy. It cannot bomb its way to a solution. Such a strategy must include as minimum first steps a clear promise that Palestinians displaced in the fighting will have the absolute right to safely return to their homes; a commitment to broader peace talks to advance a two-state solution in the wake of this war; an abandonment of Israeli efforts to carve up and annex the West Bank; and a commitment to work with the Palestinian Authority to build genuine governing capacity. The United States must make it clear that these are the conditions of our solidarity. Just as we want justice for the Israelis murdered by Hamas, we also want justice for the Palestinian people, and that is not going to happen with Hamas. Palestinians need a state of their own, contiguous, with the freedom of movement and access that can sustain a vibrant economy. This will be a long and difficult road. It will take concerted U.S. and international support and a doubling down of our political commitment to a two-state solution. But the first step right now must be to stop the bombing and bring in as much humanitarian aid as possible. I think Secretary Blinken said it well when he said: Providing immediate aid and protection for Palestinian civilians in the conflict is a necessary foundation for finding partners in Gaza who have a different vision for the future than Hamas--and who are willing to help make it real. This is a dreadful situation. It is part of a very, very long-term conflict between Israel and its neighbors. But the immediate crisis is to save lives, to stop the bombing, to bring forth a humanitarian pause, and then to go forward to bring peace and stability to the region. I yield the floor.

Mr. SANDERS

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

Mr. SANDERS. Madam President, I wanted to take a few minutes to share my thoughts regarding the horrific situation in Israel and Gaza. On October 7, Hamas terrorists waged a barbarous attack against Israel, killing over 1,400 innocent men, women, and children. Young people at a music festival were machine-gunned down in cold blood, babies and older people were brutally murdered, and over 200 Israeli and Americans are being held as hostages. Some people describe the October 7 attack on Israel as equivalent to the 9/11 terrorist attack against the United States. That is wrong. Israel is a small country with under 10 million people. On a per capita basis, the 1,400 Israelis killed by Hamas would be the equivalent of over 40,000 Americans killed if Israel had the same size population as we do--40,000. On 9/11, as everybody recalls, we lost 3,000 people. Let us be clear. Israel suffered a major attack and has, as do all other countries under similar circumstances, the absolute right to defend itself. But having the right to defend your country against a terrorist attack and a terrorist organization like Hamas does not mean having the right to violate international law and wage indiscriminate warfare against innocent men, women, and children in Gaza. The people of Israel have gone through a horrific and traumatic shock. It is understandable that they are furious and want to strike back forcefully. Revenge, however, is not a useful policy. Killing innocent Palestinian women and children in Gaza will not bring back to life the innocent Israeli women and children who have been killed. It will only make a terrible situation even worse and more intractable. Let us be clear. The Palestinian people today are experiencing nothing less than a humanitarian disaster. Thousands are already dead, including many children--perhaps thousands of children--and far more have been wounded. Hundreds of thousands have been forced out of their homes. These people--deeply impoverished before this war began--now lack food, water, fuel, shelter, medicine, and other basic necessities. Unbelievably, more than 400,000 Palestinians driven from their homes are now sheltering in densely crowded, U.N.-run schools--400,000 people in U.N.-run schools. Dozens of medical facilities have been damaged and made inoperable, and 35 United Nations aid workers have been killed. The aid trickling into Gaza is just a fraction--a small amount--of what is needed. In a few days, hospitals will run out of fuel, and ventilators and incubators will shut off. This is a desperate, desperate humanitarian crisis. I echo Secretary Blinken's call for the immediate release of all hostages and for a humanitarian pause by all parties. A pause is essential for the protection of civilians, as required by the laws of war, as well as for the provision of robust supplies of food, water, and medical aid to address the growing humanitarian catastrophe. I know that Senator Merkley and others are working hard to gain support here in the Senate for that position, and I agree with it. Israel suffered a terrible attack, but the response must be carefully thought through and be carried out in line with international law. When the United States was attacked on 9/11, we allowed anger and rage to drive our response. This resulted in making grave mistakes in terms of wars in Afghanistan and Iraq, which cost us thousands of members of the U.S. military and, in fact, the lives of hundreds of thousands of innocent people in those countries. Israel has a right to defend itself and go after Hamas, but innocent Palestinians also have a right to life, security, and peace. Please remember that the last election held in Gaza was in 2006, when a majority of people in Gaza today were not yet born or could not vote. Even then, back in 2006, a minority voted for Hamas. Hamas is an authoritarian organization that does not necessarily represent a broad swath of the Palestinian people, and we must not conflate all Palestinians with this terrorist organization. Further and of much concern to me and, I think, many others, Israel is apparently contemplating an invasion and occupation of Gaza. I have very serious concerns about what this could mean in terms of the long- term security of Israel, the well-being of the Palestinian residents of Gaza--half of whom are children--and the hope that peace, security, and justice will at some point come to that region. In Congress, we will soon be voting and debating a package which includes billions of dollars to Israel above and beyond the $3.8 billion in military aid the United States sends there every year. The American people have a right to know if that money will be used to defend Israel or whether it will be used for an invasion and occupation. Israel's proposed invasion will likely bring difficult, street-by- street fighting against entrenched Hamas fighters in a dense urban environment still populated by many civilians. Hamas will continue to use human shields and its extensive tunnel network and will likely resort to insurgent tactics. As two experts on the subject recently wrote, ``The battle will not end when Israel has reoccupied the territory. There is no Palestinian entity that Israel trusts to govern Gaza in Hamas's stead. As a result, a military victory could mean Israel has to administer the territory for the foreseeable future. Israeli officials, in other words, will have to govern an immiserated people who see them as their enemy and who may wage a guerrilla war.'' I have serious concerns about what this invasion and potential occupation of Gaza will mean, both in terms of the long-term security of Israel and the well-being of the Palestinian residents of Gaza. In Congress, as we consider a package including billions of dollars for Israel that could fund this invasion and occupation, we clearly need much more information about Israel's long-term plans and goals, as well as the U.S. Government's assessment of those prospects. These are some--some--of the questions that need to be answered: How many innocent men, women, and children will be killed or wounded if Israel engages in an invasion and an occupation? How many Israeli soldiers will be killed or wounded in an operation of that kind? How will many hundreds of thousands of civilians receive the food, water, fuel, and medical care they need in the midst of what could be extremely heavy urban warfare in a very densely populated area? How long will it take to establish military control of Gaza, and what level of insurgent activity is anticipated from that point? In other words, controlling Gaza is not the end of that process. How will the success of the operation be measured? Are there alternative approaches to a ground invasion that would be effective in ensuring Israel's long-term security? What will this operation mean for the hostages still being held in Gaza? What political force will administer Gaza after an Israeli operation? Will the hundreds of thousands of Palestinians who have been driven from their homes--they have been pushed out of their homes now, no place to go--will they be guaranteed safe return to their homes? Importantly, what impact will the invasion and occupation of Gaza have on the international community's support for Israel? How will the whole world feel about a powerful nation occupying a very impoverished part of the world? How will the international community address the ongoing needs in Gaza and the rest of Palestine when the shooting and bombs stop? What political process will follow this conflict, and what is the desired end-state in Gaza? These are some of the questions that have to be asked. As Congress considers the administration's emergency funding request, we need answers to these questions. This is, tragically, the fifth conflict between Israel and Hamas in 15 years--fifth war in 15 years. Clearly, a terrorist organization like Hamas cannot be the answer to the very serious problems facing the people of Gaza. Just a few months ago, thousands of people defied Hamas's authoritarian rule to protest on the streets of Gaza. They stood up, with great courage, against Hamas's authoritarian rule. Their voices are silenced now, but there can be no long-term solution to this ongoing crisis without a serious effort to address Palestinian demands for peace, legitimate political representation, and a vibrant economy. I would just mention one fact, and that is, before this war, some 75 percent of the young people were unemployed. So you have, aside from everything else, an economic disaster in Gaza. In my view, the United States must take a leading role in charting out a future that respects the lives of Palestinians and Israelis alike. We can start by answering the questions laid out above, and I very much look forward to receiving from the administration a briefing, in a classified setting, if necessary, in order for Members of Congress to understand what an occupation and invasion will look like. We are living in a horrifically difficult moment in the Middle East, and I can understand the outrage that many people in Israel feel in terms of the attack that killed 1,400 of their people, but now is the time, in Israel and in the United States, for us to not allow revenge and rage to dictate our policy but to really think this issue through. I yield the floor.

Mr. SANDERS

Mr. SANDERS. Reserving the right to object.

Mr. SANDERS. Madam President, I listened carefully to what Senator Scott and others have said about the barbarous acts committed by Hamas against innocent men, women, and children--the mowing down by machine guns of young people who were doing nothing more than attending a dance; the murder of babies. This is a horrific--horrific--act, precipitating a worldwide crisis, and the United States of America--all of us--condemn this act. In my view, the State of Israel has the absolute right to defend itself against Hamas and terrorism in general--no debate on that. But what I ask my colleagues to also consider is that while we fully appreciate the horrific attack by Hamas against innocent people of Israel, I ask you also to understand that right now there are hundreds and hundreds of thousands of innocent men, women, and children in Gaza who have lost their homes. They have been thrown out of their homes. They have no food. They have no water. They have no fuel. And I remind my colleagues that half of those people are children. Half of the people in Gaza are children. So, yes, we are united in doing everything we can to destroy Hamas and their terrorism, but I implore you, do not take Hamas's inhumanity and brutality and terrorism against children who are 3 or 5 years old. I ask you to think for a moment. Think about it. I have a State that I represent, the State of Vermont--630,000 people. A million people-- most of them are poor. They had nothing to begin with. Before this whole business, Gaza was one of the most desperately poor places in the world. Youth unemployment was 75 percent, many of their people dependent on the U.N. for basic survival. So what I am asking people to take a look at is to understand what our country is about, and what our country must not be involved in is making the horrific and miserable situation in Gaza even worse. Many of the families--and, again, these are people thrown out of their homes. They don't know where they are going. They don't know who will accept them. They don't know if they are ever going back to their homes. And they were poor to begin with. Do we really want to deny those people aid from the U.N. and other agencies to feed the children, to provide water for them? Is that really what we are about? Of course, it goes without saying that we have to do everything we can to make sure that not one nickel goes to the murderous Hamas organization, but at the same time, we have to stand with the innocent women and children in Palestine who are suffering today and are facing an almost unprecedented modern humanitarian disaster. So today, in the midst of this crisis, U.S. and U.N. assistance in Gaza is aimed squarely at addressing the basic needs of the Palestinian people, including humanitarian aid and water and health programs. The United States and the United Nations go to great lengths to ensure that aid gets to the people needed and is not diverted, through trusted partners like Catholic Relief Services. The Israeli Government itself recognizes the importance of this U.N. humanitarian aid and has long supported it. Today, in the midst of this horrific crisis, the United States and the international community are working to secure humanitarian access-- and from media reports I have seen recently, we may be making some progress on that--so that the U.N. can get food and water and fuel and medicine to the million or more people in Gaza who need essential supplies. That should be our focus. There are people now facing hunger, they are facing incredible desperation, and we cannot-- cannot--turn our backs on them. If you think this is going to be good for Israel, if you think that the suffering of the Palestinian people long term is good for Israel, I think you are sorely mistaken. The world is looking at us, and the world understands that what Hamas did was terrible, but they don't want to see our great country turn its back on innocent women and children. That, in my view, is not what this country is about. This is a tough issue. There have been four wars there in the last 15 years. It ain't going to be solved tomorrow. But while we do our best to support Israel and destroy Hamas, please, let us not turn our backs on the suffering people in Gaza. This is not what we should be doing, not what Congress should be doing, and therefore I object.

Mr. SANDERS. The thing is that hundreds of thousands of women and children are living in desperation today. And nobody in the world can guarantee that a bottle of water may not go to somebody connected to Hamas. If you are insistent upon that, what you are really saying is, no money for Gaza. So, with that, I object.

Mr. SANDERS

Mr. SANDERS. Mr. President, I ask unanimous consent to have printed in the Record at the appropriate place the commitment letters for the Animal Drug User Fee Amendments of 2023 and the Animal Generic Drug User Fee Amendments of 2023.

Mr. SANDERS

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

Mr. SANDERS. Mr. President, let me begin by thanking Senator Marshall of Kansas for his very hard work on the bill that we have introduced today after being on the floor with me this afternoon to briefly discuss it. And I also want to thank his staff and my staff for putting in an enormous amount of time on this bill over the last several months. Most Americans understand that our healthcare system is broken. We are spending nearly $13,000 a year per capita on healthcare. That is an astronomical sum of money, almost twice as much as most other countries. And yet despite all of that spending, some 85 million Americans are uninsured or underinsured. And there are estimates out there, believe it or not, that some 60,000 Americans die each year because they do not receive the healthcare they need when they need it. And our life expectancy as a nation is actually in decline, despite all of that spending. Frankly, as broken as our general healthcare system is, our primary healthcare system is in even worse shape. As everyone knows, I don't think there is any debate on this, we face a major shortage of doctors, nurses, mental health professionals, and dentists. And those shortages will only grow as a result of the COVID burnout that many providers experience and the aging of our healthcare workforce. According to the most recent estimates that I have seen, over the next decade, our country faces a shortage of over 120,000 doctors, including a huge number of primary care physicians. The nursing shortage may be worse. Over the next 2 years alone, it is estimated that we will need more than 200,000 nurses. And despite the very serious mental health crisis we face, we are facing a massive shortage of mental health providers--psychiatrists, psychologists, social workers, et cetera. Now, that is not the point that Bernie Sanders is making or Senator Marshall has made. This is a point of view of virtually every major medical organization in the country. And on this matter, let me quote from a recent Washington Post op-ed by Elizabeth Rosenthal, a contributing editor at Kaiser Family Foundation Health News. This is what she writes--and I hope our colleagues hear this: American physicians have been abandoning traditional primary care practice--internal and family medicine--in large numbers. Those who remain are working fewer hours. And fewer medical students are choosing a field that once attracted some of the best and brightest because of its diagnostic challenges and the emotional gratification of deep relationships with patients. The percentage of US doctors in adult primary care has been declining for years and is now about 25%--a tipping point beyond which many Americans won't able to find a family doctor at all. She writes: Already, more than 100 million Americans don't have usual access to a primary care doctor--a number that has nearly doubled since 2014. Mr. President, I ask unanimous consent to have printed in the Record the full article.

Mr. SANDERS. Mr. President, now, what this article points out is certainly not news to the people in America. In Vermont and all over this country, our people often have to wait months in order to get an appointment with a doctor; and in some cases, they have to travel very long distances to get the healthcare they need. And let us be clear: There is no debate upon this. Some people think we don't have to act on it now; let's do it next year, next year, following year. Wrong. The crisis is only going to get worse, and every day we delay it, it becomes even worse. Now, why is this happening? Well, there are a lot of reasons why. One of the reasons is that it turns out that the United States--despite all of our spending on healthcare--spends about half of what other nations do on primary healthcare. We spend approximately 7 percent; most of the country spends at least twice as much. And the absurdity of that situation is that everybody knows that ``an ounce of prevention is worth more than a pound of cure.'' And if there is anything that Senator Marshall and I are talking about, that is exactly what we are talking about. You spend money--we are spending money to save money. Keeping people healthy saves money. In other words, common sense tells us that if we can prevent disease, do a better job keeping our young people healthy, if people can access the medical care when they need it not when they are just very, very sick-- if we can do those things, we can keep them out of the hospital. And hospital costs are just extremely, extremely high. Common sense also tells us that it is literally insane that millions of Americans with nonemergency healthcare needs get their primary care in a hospital emergency room, which, in some cases, is 10 times more than the care provided them in a community health center. Let me just give one other example of the irrationalities of our current system. In my own small State of Vermont, last year, our major hospitals spent $125 million in 1 year on traveling nurses because we don't have enough local nurses to support the needs of the hospital and many other facilities in Vermont. Meanwhile, young people want to become nurses. They are applying to nursing school, but the nursing schools don't have the faculty to educate them. I recently talked to a Senator who told me that, in her State, some 1,100 young people were applying for a space in nursing school; the school could only provide 80 openings. So we have a nursing crisis. We are not addressing it. Hospitals are spending three, four times as much money on traveling nurses as they are on homegrown nurses because we are not educating our young people at nursing school. This may make sense to somebody; it does not make great sense to me. The legislation that Senator Marshall and I have introduced today does not solve, by any means, all of the healthcare crises we face. But if this legislation is passed, it will not only save us substantial sums of money, not only provide a medical home for millions more Americans, not only significantly increase the number of doctors and nurses that we desperately need, but it will go a long way toward transforming primary healthcare in America--something that is so long overdue. With that, I want to turn the floor over to Senator Marshall. And I would say this, that Senator Marshall has a unique perspective on this. Not only is he a Senator from a rural State, he is also a practicing physician and has interesting insight into the crises in healthcare that many of us don't.

Mr. SANDERS. Mr. President, this is an issue I have worked on since I have been in Congress. And one of the results of that--working with others--is that, in my State of Vermont, I think--I think--we are leading the Nation in terms of the number of people per capita who participate in the community health center program. Senator Marshall, my understanding is that in Vermont, one out of three Vermonters get their primary healthcare or dental care at a community health center. And one of the things that I love about community health centers is that they really are community health centers. In Vermont, they are not just for low-income people, as important as that is. They are for everybody in the community. We used to have a Supreme Court Justice of the United States of America who vacationed in Vermont. Guess where he went? To a community health center. My understanding is, the Governor of the State of Vermont gets his primary healthcare at a community health center, and that is what I love about them. And as you well know and as you mentioned, what they do is not only provide primary healthcare, many of them provide dental care, which is a huge issue. Many of them provide mental health counseling, which, as you indicated, we have a major crisis in. And they also provide lower cost prescription drugs. What they say is that, regardless of your income, if you have Medicare, come on in; if you have Medicaid, come on in; if you have private insurance, fine; if you have no health insurance, we will work on a sliding scale. By expanding these community health centers all over America, we are going to provide millions of people the opportunity to get the healthcare they need. That is what exists in Vermont right now, and we want to see that expanded all over the country.

Mr. SANDERS. Thank you very much for raising the issue of dental crisis in America. I can tell you that in Vermont, we have a crisis. We made progress, but we have a serious problem. The cost of dental care is very, very high. In the southern part of my State, Bennington County, if you are a poor child, you are probably on Medicaid. You probably can't find a dentist. What we have done in this bill is put $3 billion one time--just one time--into capital improvements for community health centers. That is long overdue because if you want to expand community health centers, they need money for their own expansion and infrastructure. Building a dental operatory--and that is the dental chairs and the good equipment that dentists need--is a very expensive proposition. So by putting $3 billion into capital improvements, much of which I suspect will be going to those dental operatories, we are going to be able to provide communities all over this country with the ability to access dental care in a way they are not doing it today.

Mr. SANDERS. Senator Marshall raised this issue from almost the first time we sat down and seriously discussed it. If we are going to talk about prevention, we have to talk about obesity, among other things, because we are looking at a major--you tell me if I am wrong, Doctor-- we are looking at a major diabetic epidemic in this country that will not only cost massive amounts of suffering, but it is also going to be a very expensive healthcare bill. Certainly, one of many of the contributing factors is obesity. What Senator Marshall has talked about from the very beginning is we have to do a better job in nutrition education. Community health centers are very well-situated to be able to do that. At Senator Marshall's insistence--and I was delighted to work with him--we have language in here that will make it easier for community health centers to work on nutrition programs in a variety of ways with their clients.

Mr. SANDERS. Let me thank Senator Marshall and his staff so much for their hard work and say, as he just said, we think there are other ideas that can improve it. We are open to new ideas. We hope to be marking up and intend to be marking up this bill next Thursday. We look forward to talking to all of the members on the Health, Education, Labor, and Pension Committee for doing what is really important. Senator Marshall started his remarks off by saying, I think, exactly the right thing. We can come here and all give great speeches. We can all talk about how next year, we are going to get to something or, 5 years from now, we will get to something. Everybody in America--in Vermont, Kansas, and all over this country-- understands we have a primary healthcare crisis. This is the greatest country on Earth. We spend more money on healthcare than any other country. It is not asking too much that when you get sick, you are able to find a doctor, that you are able to find a dentist. It is not asking too much that when you are in a hospital, there are enough nurses there, that our young people who want to become nurses are able to get that education so they go out and get really good jobs. That is not too much. That is all we are doing in this legislation. We are looking at the real world as it exists. Senator Marshall is a physician and understands that world quite well. We are looking at that world saying: You know what, let's not wait 5 years from now. We have a crisis today. Let's deal with it. I yield the floor. I suggest the absence of a quorum.

Mr. SANDERS

Mr. SANDERS. Mr. President, I call up my amendment No. 1030 and ask that it be reported by number.

Mr. SANDERS. Mr. President, our healthcare system is broken. Eighty- five million Americans are uninsured or underinsured, and we don't even have enough doctors, nurses, or mental health providers. Unbelievably, our life expectancy is actually declining. Our childcare system is dysfunctional. Millions of parents are unable to find affordable sites for their kids. We have a major housing crisis, 600,000 Americans are homeless, and-- oh, yes--the planet is on fire, and the world we are leaving future generations will be increasingly unhealthy. But somehow we never have enough money to address those crises. Mr. President, if we have learned anything from the COVID pandemic, where we have lost over 1 million Americans, and climate change, which is causing massive destruction throughout the world, it is that national security is not just about nuclear weapons, submarines, and fighter planes; it is about making sure that all Americans have decent healthcare, education, housing, and other necessities of life.

Mr. SANDERS. Mr. President, I ask unanimous consent for 30 more seconds.

Mr. SANDERS. Year after year, with very little debate, we pour hundreds of billions of dollars into the military-industrial complex. This year, it is about $900 billion. While defense contractors make huge profits, while the Pentagon remains unaudited, with massive waste and fraud, we now spend more than the next 10 nations combined. Enough is enough. It is time to change our national priorities, and cutting military spending by 10 percent is a good way to begin.

Mr. SANDERS

Mr. SANDERS. Reserving the right to object

Mr. SANDERS. Let me begin by thanking Chairman Wyden for his leadership on the need to fundamentally reform our Nation's organ transplant program. I share his concerns. A 2020 bipartisan Finance Committee investigation that Chairman Wyden co-led with respect to the current system found ``lapses in patient safety, misuse of taxpayer dollars, and tens of thousands of organs going unrecovered or not transplanted . . . resulting in fraud, waste, and abuse of our Nation's Medicare program and American taxpayer dollars.'' That is unacceptable and that has got to change. The legislation Senator Wyden would like to pass in the Senate today by unanimous consent, while not perfect, includes important reforms to the current system that I support. Once it is signed into law, there may need to be some technical changes to it that I look forward to working with Chairman Wyden and my other colleagues on. All of us believe that the administration should have the flexibility it needs to fix the current system. We also believe that corporations should not be able to make an outrageous profit from the organ network. As my good friend from Oregon knows, this bill is within the jurisdiction of the HELP Committee, a committee that I chair. Before I withdraw my objections to the organ transplant bill, I want to raise an issue of enormous importance to the American people, and that is the need to address the very serious primary care crisis in America and the massive shortage of doctors, nurses, mental health professionals, and dentists in America. As my colleague from Oregon knows very well, tens of millions of Americans are unable to access the primary medical care, dental care, and mental health care that they desperately need. As everyone in America understands, we don't have enough doctors, nurses, psychologists, psychiatrists, dentists, and home healthcare workers in our country. As the Senator from Oregon knows very well, on September 30, mandatory funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers will expire unless Congress acts, and Congress must act. The HELP Committee is working on bipartisan legislation, not only to reauthorize these critical programs, but to significantly expand them. We need a major expansion of Community Health Centers in America to make sure that tens of millions of underserved Americans not only receive the primary care they need, but are also able to receive the high-quality mental health care and dental care they need as well. We need a major expansion of the National Health Service Corps Program, the program that provides scholarships and debt forgiveness for doctors, nurses, dentists, and mental health providers who are prepared to work in our Nation's most underserved areas. We need a major expansion of the Teaching Health Center Program, the Nurse Corps, and the Nurse Faculty Loan Program, among many other things. Of particular concern is an issue I heard about from every single major medical organization in our country, and that is that over the next decade, our Nation faces a shortage of more than 120,000 doctors, including a major shortage of primary care doctors. I don't know how we can grow the number of doctors in America without expanding the Medicare Graduate Medical Education--GME--Program, a program that is within the jurisdiction of the Finance Committee. Let's be clear. The problem is not so much about the number of doctors graduating from medical school. No, the problem--the bottleneck--is that some 6,800 applicants for a residency position don't match into a program due to a shortage of spots. As my colleague from Oregon knows, if a doctor graduates from medical school but cannot get a residency slot, that person cannot practice medicine in the United States. In my view, it is critically important that we expand the GME Program. There is bipartisan legislation that does this: S. 1302. The Resident Physician Shortage Reduction Act of 2023, led by Senators Menendez, Boozman, Schumer, and Collins, would raise the number of GME positions by 14,000 over the next 7 years. Consistent with legislation that passed the House last Congress, I believe that a significant percentage of these additional slots should be dedicated to primary care and mental health care. As you know, the Medicare GME Program is within the jurisdiction of the Finance Committee, and the other programs I mentioned are within the jurisdiction of the HELP Committee. I ask my good friend and colleague from Oregon, will you commit today that as chairman of the Finance Committee, you will do everything within your ability to pass bipartisan legislation in the Senate that includes a major expansion of the Medicare Graduate Medical Education Program?

Mr. SANDERS. Sure.