trading mental disability. the principal arguments against the linkage is that it will be viewed by some stakeholders as a mechanism to reduce disability payments and vis-a-vis mental disabilities. it could be addressed with carefully regulations and policy drefbts. the vdbc offered a recommendation that offered an approach to compensation that recognizes the relapsing and remitting nature of these illnesses. regarding the differences and approach to physical versus mental disabilities there's significant evidence that individuals with mental disabilities are less likely to seek and maintain a treatment regiment than those with physical disabilities. there's, of course, a resource built that accompanies an expanded treatment mandate and the committee was aware of that and as i'm sure most of you are. however, the vdbc recommendation

to link compensation, treatment, vocational assessment and training and periodic evaluation offers the opportunity to reduce homelessness, and substance abuses among the veterans. such an approach should offer some offer some long-term help for mentally disabled veterans and their integration into society. i would like to thank you mr. chairman and members of the community to present to you today. i'll be happy to address any questions now or as the hearing goes forward. thank you. >> dr. satele? >> thank you, mr. chairman. and committee for the invitation to be here. my name is sally satele. i'm a psychiatrist who formerly worked at a va in west haven connecticut and now i'm a resident scholar at the american enterprise institute. in the current testimony as we've seen and as we've been discussing, a veteran can

testify disability compensation, excuse me, for a psychiatric condition that's never been treated. a straightforward approach to bridging this gap and the kind that general scott has been focusing on is an urge, of course, to urge vdbc so claimants are referred to treatment. while it's a definite advantage over current practice does not address the timing issue. that is whether veterans necessarily benefit when the disability claims process can precede care and that's what i want to focus on now. we have to consider the fact that compensation before care, that kind of a sequence of granting disability claims before a veteran has been treated can sometimes have

significant drawbacks. for one thing, it is very difficult for a compensation manager, comp and pension manager to make an accurate assessment of a future veteran's function is that whether or not he or she will continue to be disabled in a way that impairs employability before treatment has been taken place. as clinicians know, not everyone in pain with symptoms or a diagnosable mental health disorder is going to be disabled. that is impaired in terms of future workplace function. beyond the matter of accurately judging functional impairment, which has as i've been saying which is kind of hard to be doing without a cmp manager without the person being in treatment and rehabilitation first, there is the possibility that with our current sequence of being allowed to receive and file disability claims before treatment, that despite the best

intentions of this system, awarding disability status prematurely especially at levels that indicate unemployability can actually complicate the veteran's path to recovery. now, consider the example below as an actual case. a young soldier, we'll call him joe, who was wounded in afghanistan, he has classic ptsd, noises make him jump out of his skin, he's flooded with bloody memories and nightmares, he can barely concentrate and he feels emotionally detached from everything and everybody. he's 23 years old. about to be discharged from the military. he's afraid he'll never hold a job. he'll never intergrate fully -- and function fully into society and he applies for total disability compensation from the dva. and on its face this seems quite logical and awarding those benefits seem quite humane but in reality this is probably the

last thing that this young soldier turning veteran needs. and what i mean by that is that compensation at a high level can confirm the fears that, in fact, he will remain deeply impaired for years if not for life. i mean, now that's a sad verdict for anyone. but it's especially tragic for someone who's only 23. you know, imagine telling someone with a spinal injury that he'll never walk again before he's even had surgery or physical therapy. now, a rush to judgment as well meaning as it is about the prognosis of psychiatric injuries can carry significant long-term consequences insofar as a veteran who is unwittingly encouraged to see himself as seriously and chronically disabled risk fulfilling that prophesy. why should we even bother with treatment he might think which, of course, is a terrible mistake because this period soon after

operation as the veteran is quite young is when the mental wounds are most fresh and when they are most responsive to therapeutic intervention. but joe is told he is disabled. and he and his family may assume, typically incorrectly, that he will never be able to work. he'll no longer be able to work. this becomes a self-fulfilling prophesy in many cases and ending up depriving the veteran of the -- of work itself which has enormous therapeutic value. it's also quite demoralizing and once a patient is caught in a downward spiral of invalidism, it can be very hard to throttle back out. for example, even if he wants to work very much, he understandably fears losing that financial safety net. if he were to get off the disability rolls. now, of course, this suggests everything i've said so far suggest a sequence that would begin with treatment and move to

rehabilitation and then if necessary, the veteran would go on to become assessed for disability if he was not improving. but this can't be all. any person who's too fragile for employment while he's in treatment will need to receive a living stipend, a treatment-first approach could not work with this. excuse me, a treatment-first approach could not work without some sort of living stipend for the veteran and his family. now, in closing, however, this gap between care and compensation is to be closed, there's at least four important things to remember. first, there has to be sufficient information for the comp and pension examiner. he needs to make a good determination about ongoing employability and without a quality course of treatment and rehab there's often not enough information to make judgments about disability. two, accept for total and permanent disability and iu status, reoverse-evaluation and

evaluation two to five years and a level of improvement. four -- excuse me, three, while a veteran's getting care, neither he, she, nor the family should suffer economically. and four, we should try as best as we can to avoid premature labeling, the downplay of disability, avoid premature label of disability that downplays the recovery prospects. it's reasonable and important to instill the expectation that most veterans will get better. they are changed by their wartime experience naturally but that they will find a comfortable and productive place in the community and their family. finally, conferring a high level disability status upon a veteran and the dysfunction that that implies before his prospects for recovery are known can make the long journey home even harder than it is.

thank you very much. >> thank you very much, dr. satel. you raised the issue of prematurely granting of the disability and the consequences of a perverse disability it may have. how can we balance the need to encourage early treatment when many members are returning from combat and disappearancing mental health problems and i think you may addressed it a treatment with some type of a stipend. but could you elaborate a little further? >> well, that's the basic idea. that there would have to be some sort of living stipend. the important thing in my view is to not call it disability. it could be -- it could be even more generous even than his disability rank might have been if he were assessed for a claim right out of -- you know, right off the bat without first

getting treatment. that's not my concern. my concern is that the family and he not worry about their support. that will impair his ability to get better. of course, just that financial security so anxiety provoking i don't know how anybody could get better and i don't think the family should suffer as well. call it a wellness stipend, call it a wellness treatment but call it something. i personally prefer -- the word "disability" has so -- when i worked in the clinic and i saw it in the social security and in the va that i feel the language here is important as well.

>> yes, sir, i would say that it does. i would say that we have an opportunity here with this young group of veterans to start a process that we have not chosen to begin in the past. but i would say that it probably should -- it probably should apply to all. you know, i would be the first to say and i'm certainly not a clinician or a medical doctor. that every case is different and the clinician should be the person is to decides is it every two years, three years, five years or whatever. so it's probably not a cookie cutter approach but it's something that i believe that could be decided inside the treatment part of vha. >> and dr. seal, in your testimony you said despite the initial use of va mental health services among oef/oif veterans, retention in va mental health services appears less robust.

you also noted that compared to studies of civilians retention in va mental health treatment appears inferior. how do we improve it? >> well, i think i laid out in my oral testimony some ideas for how to improve it. we know that oef/oif veterans are coming into primary care. they're coming into primary care for physical complaints which often pain and other physical complaints often do keep company with ptsd and depression. so they come to primary care. we're trying to meet the veterans where they are at least in our clinic. i think we run into difficulties when we separate mental health from primary care. and we don't adopt a more wholistic approach. it is very different sometimes for veterans to come into primary care, seek care for their physical complaints then have a separate appointment and a separate time in a separate building for their mental health complaints. i think if we can bring the two

together, more wholisticly, i think veterans will be more likely to stay in care. >> and i think that sometimes it's difficult to come to the va at all. people have jobs. they go to school. and i think we really have to be open to more innovative approaches to deliver specialty mental health care and that's why i brought the use of the internet, the use of the telephone, even iphone applications that can serve as mental health treatment adjuncts. i think we need to broaden our vehicles through which we deliver specialty mental health care. >> thank you. >> thank you for your testimony. dr. seal, i appreciated your specific recommendations and i think they have a lot of merit from my own experience. so much of the testimony that we get of people who have had problems, suicides, mr. hanson who was on the panel in front of you -- i don't know if you saw his written testimony, but each

of the suicide cases that occurred in the united states was preceded by attempts to go to the va for help. and he used the phrase, furnishturned away. they almost have to fight to get care. i just had a constituent -- he was fighting for months for them to take him seriously. and nothing occurred and he committed suicide. so once you get in and seen, you know, your reforms make sense but what is going on with -- the testimony that we get i mean, is it subjective or is that their impression. even if it's their perception, it's obviously meaningful. why do so many people feel they can't get the help that they need when they go to the va? i mean, it seems that all of the cases that we hear about involve that in some way? >> uh-huh. well, i think you raise a very,

very important concern. i do meet veterans who come in to my clinic who do say that it was hard for them to figure out how to come into our clinic yet there are other veterans who walk into the building, go to the combat case manager, are literally escorted upstairs, an appointment is made and in many cases they're seen the same day so -- i think there's a wide variation of experience, which isn't to say that it isn't tragic when one person is not able to get services and commit suicide -- >> but in a national system that we have, why is there such variation? don't we have common policies and supposedly common training? >> i think -- i think there are common policies and i think there are -- there are common standards but i think there really are regional differences, and i think that some va -- va facilities are not all created equal. we have va medical centers, we have va community-based

outpatie outpatie outpatient clinics that don't fall under that assumption and some are not resourced with outreach workers and administrative staff to handle the influx of veterans that are coming in. i actually think we could use more combat case managers. in fact, at our va medical center, i just learned they're no longer called oef/oif combat case managers. they are now in some more generic social service role and i think it's exceedingly important that we maintain that particular position at all va facilities so that we have va outreach to communities. and when va -- when veterans come in to va, they're met with somebody that knows exactly what they need and can literally escort them through the process of enrolling through member services and then receiving care.

>> you might supplement your written recommendations with looking at that aspect, too, for us. that would be great. by the way we've had hearings in this room recently and we'll have more on employment and we have hearings on ptsd. i mean, surely some of the we have, 20, 25 -- they could get training in this but, you know, the most important thing their brothers and sisters are coming in and they could help guide them. do you think there's a bigger role with people and you could work with them and get some of the training they might have -- >> i think that's an excellent idea. >> i think -- we need to have an responsibility to these kids to do that. >> but again, we have to look at our resources and at our va there's a hiring freeze. i'm not exactly -- >> i don't mean to interrupt you. mr. chairman, i've heard this in several places.

there's a hiring freeze. i mean, we have the biggest problem we've ever had. we have given the va more money than they've ever had and we keep hearing about hiring freeze. what is going on here? i mean, we're underresourced, you say. i mean, we have increased the va budget every year for the -- you know, as long as we've been here, and, you know, it's 60, 70% higher than it was just five years. what is going on? do you have any sense of that from where you are? >> well, i mean, i think it's important to lock -- i'm a primary care clinician and i'm a researcher so i don't know that i can answer for va. >> i keep hearing this and yet from our perspective, we keep pouring in money. and then everywhere there's a hiring freeze? >> it depends where you want to spend the money. the money has been spent to greatly expand mental services and we're hiring psychologists

and services but what you're talking about is different. you're talking about an outreach worker, which is -- >> you say you have a hiring freeze. who do you have a hiring freeze on? >> i don't know if there's a hiring freeze on everybody at the san francisco va. i know for clinicians there is because we have greatly expanded at least our mental health services capacity. that may not apply to outreach workers. i actually don't know. >> by the way, you have joint employments with the university and -- what percentage of each -- you have with each? >> i'm 5/8 va and 3/8 university employment. >> i mean, i know hospitals where there's 1/8 va, 7/8 university. and we say we have eight psychiatrists on, you know, on our staff when there's only one, which is also i think -- at this point in time, i mean, i never underrate the importance of

research and, you know, and your daily -- you know, your own integrated life, but with all this clinical needs it seems we shouldn't be putting people on 7/8 time and if they want to do research, let them do it but let's get a full-time clinician in there. >> just to clarify, i'm based 100% at the va so i am partially supported by the university through my own grant funding but i am based 100% time at the va. >> okay. >> and interestingly, all of my research involves access to mental health care for oef/oif veterans. >> i understand. i know universities there, it's the other way around, they're mainly at the university. mr. chairman, it seems we have a heart of a problem where we keep thinking we're giving the resources. we hear from the field and from people like mr. hanson we just don't have the resources to do the job. so we got to figure out -- >> we did hear yesterday, you know, in our sexual assault hearing that we had where we

thought dollars were being sent for security and we're now finding out some of those doctors are being redirected and not going where it needs to be. so, obviously, it's outside your lanes. but it is an issue that this committee needs to address. i thank you, mr. filner. >> thank you very much, mr. chairman. dr. satel, with regard to your proposal, are you saying the veteran will not seek the treatment, the disabled veteran, because he has financial obligations and also maybe possibly because of a stigma? and then i want to also -- well, why don't you ask -- why don't you answer that question first? >> well, the reason for the financial stipend would be because if we expect people to be in treatment and even if the possibility was endorsed of actually requiring it and i know

that's very controversial, meaning requiring it as a condition of being considered for disability, you certainly can't expect somebody to be in treatment, intensive care before -- intensive care that, a, that takes up a lot of their time where they would otherwise be working or that they are simply not fit to work. you can't expect that of them without -- without providing income support. >> and i definitely need -- and definitely we have to have this stipend if we go forward with this. the other question is, how long -- what kind of a time frame are you talking about as far as determining a person's disability rating? if you can answer that question as well? i guess, does it depend on an individual case? >> definitely. definitely. >> okay. but can you give me maybe a time frame, an approximate time frame? >> well, for some -- for some individuals, who were very

impaired at the time, it could take up to a year. for others it could take up to a few months. >> thank you. can i ask the panel if they wanted to give their opinion whether this proposal has any merit? you're welcomed to respond if you'd like. >> i think it's an interesting proposal. immediately, i think i was struck with just something that i know clinically and that is that i know when a veteran is ready to come forward for treatment is probably the best time to treat them and i'm a little concerned about the potential for coercion or the sense well, it's now time to get treatment and we'll pay you to do it and they're not truly ready or receptive for treatment. i was struck with our previous testimony that when he was ready for treatment, he found the right treatment and he responded to it. and i see that over and over again. i don't think that people all

develop ptsd symptoms at the same time since they leave the service, i think there's a natural history of ptsd. i think some people develop it immediately. some people it can take years to develop. people are ready for treatment at different times. often, you hear a hitting bottom phenomenon so i worry about sort of institutionally -- the institutionization of treatment or a semi coercion or payment for treatment. just some concerns. i'm not saying that it's a bad idea across-the-board but i think we would ha for someone

who is significantly disabled. while undergoing treatment as it required, as was pointed out. i think you have to be careful about forcing people into treatment who are not ready. but on the other hand, i think we have an obligation to try to be sure that all the people who are ready are enrolled and getting the treatment back to mr. filner's comment earlier about people who commit suicide or do things -- and then they say well, we couldn't get treatment. so i think it's -- this is a complicated issue. and there's no -- there's no one solution fits all. but i do believe that a

relationship between treatment and compensation and an assessment which gets at dr. seal's question. and some follow-up evaluations can be worked out in such a way that it -- it's beneficial. >> thank you very much. thank you. i yield back, mr. chairman. >> thank you very much, mr. chairman. dr. seal, in your testimony you pointed out that older national guard and reserve veterans are at higher risk for ptsd and depression. can you speak to why members of the guard and reserves face this unique mental health challenges? >> well, i think part of it is the discrepancy that happens when you take an older guard or reserve member who is established in their community or their job and there may not be as much training for them. you put them in a war zone. they may be less well equipped

to be in that war zone than activity duty personnel and then they come back and are expected to reintegrate into their jobs, their communities, their families and i think the disparity between those two worlds sometimes can be truly great. and overwhelming. and i think that's why we tend to see that in older guard and reserve members as compared to younger guard and reserve members who may -- who may be a little less established already in jobs, communities, et cetera. >> thank you. dr. satel, when we talk about ptsd, there's been a focus over a number of years -- the last few years has been on oef/oif veterans. you know, that being said, that there's definitely a significant number of vietnam veterans with ptsd from the vietnam war. in your work, have you seen any

unique needs for us addressing the vietnam veterans as it relates to ptsd compared to the oef/oif veterans? >> well, one thing that's very relevant it seems to me, the people who are from the vietnam era is that from a developmental standpoint, they're now entering the retirement phase of life. and that is when a lot of folks, not just veterans, but a lot of people feel when they finally retire, it's -- they're sometimes very excited about it but it also can be a very stressful dislocating milestone in one's life. that's also coincident with aging and illnesses and your spouse getting sick. and that's the time where veterans can be vulnerable to a

recurrence of symptoms that has been dormant for decades often. and as i said, we often see that with regular civilians, where people get kind of -- you know, go through a period of depension and it's a dislocation at that time. in the case of veterans who had ptsd symptoms at one time, this is the period where they should be alert for resurgences. it's treatable in almost all cases and people do regain their footing but it's a period that can be fragile and we should be aware of that. >> in order to address that issue, specifically, with the vietnam veterans, what do you think the va should be doing as far as, should they be doing different types of programs or to address that concern that you just raised? >> again, that depends on what the person presents with. if they present with a severe major depression or a full blown

recurrence of symptoms, we sort of symptomcally treat them but for many people it's a kind of -- it's a kind of psychological process where they come to terms with -- they have to figure out really how to start the second or third part of their life and again, that's the sort of regrouping and rethinking that many people go through. and those strategies are again highly individual and you treat everyone, you know, with their own situation and you'd want to know what their interests were, you know, how people, again, find themselves as they mature, just, frankly, a competent clinician should be able to navigate someone through that

phase. >> i thank you very much. >> would it surprise any of you at the panel -- i was just looking over some numbers from 2001, vietnam-era ptsd claims or benefits, i guess, 106,801 is the number, the base number, 2010, the number now is 269,000. does that seem inordinate to you? ..

>> who thought that ptsd was somewhat of an imaginary disease, that it was, it wasn't there. and i think that over this great of time between '01 and the present it has become certainly more widely recognized. this is not to say that there was never recognition during that period of time because clinicians and others, a lot of books and written an understanding. but for the average person, veteran or non-veteran, knowledge and understanding of ptsd is a fairly recent phenomenon, so that would be .1 on the increase. people suddenly realized i've got, i have some of these symptoms. they would say, my husband has

some of these symptoms. i'm going to get him in and get him checked out, or whatever. so i think that was a part of it. also, the opportunity to receive treatment inside the va, in my judgment increased dramatically over that period of time. and so, whereas in 2000-2001 if a person had presented and said i've got this, i've got that, this is wrong, this is wrong, it probably would not have been sort of categorized saying okay, well, these are symptoms of ptsd, some of them. so we are going to get him into a treatment program that the va now has, which was not present in the past. so that's two of them. there's also been come and i've seen this somewhat advisedly, some about of people who, as

they reached retirement age, were looking for and perhaps some other, they went through a process and they realized they had a problem, and they presented themselves to the g8 or to medical authorities and said, you know, i am really doing poorly here. i think those are three aspects of but probably not the only three that i deferred to these clinicians here to either amplify that or to refute it. >> sounds right. >> a very good. colonel johnson. >> thank you, mr. chairman. i thank the panel for being here today. as a veteran myself, i have great concern about our young men and women that are coming

back today experiencing ptsd. i've long maintained that there is one segment of our society here in america that we owe it entitlement to come and that's our veterans. it's a vitally important when they come back, i mean, they're coming back today with experiences that most of us cannot imagine. they have seen their friends killed. they seem their friends dismembered -- they've seen their friends dismembered, disfigured. maybe they'd even suffered that themselves. and yet, we continue to debate as the chairman and ranking member have said, we continue to have these questions over and over and over again about the accuracy of the care.

you know, the veterans, one of the things that help them most when they get back is family support. dr. seal, are there specific programs that reach out to the families of the veterans that have ptsd to help them understand how to deal with their loved one who is suffering? >> well, i can speak, you know, most informed about our own va medical center. i do know that nationally nationwide, va is putting a great emphasis on the family, on support of families, and trying to educate families asked them how they can help detect assistance of ptsd and other mental health problems, and how they can help their loved one access care. so there is very recently, there is a lot of emphasis being directed at the family from va

nationwide. at our va we have a very robust family counseling program, and i really am very happy and pleased to say that when a veteran comes to see me and expresses marital problems, problems with parenting, domestic violence issues, that i do have a specific place to refer them. and i know that they are going to be taken well care. and it's not just for the veteran but also for the veterans and spouses and/or the children as well, which i don't know how unique that is but i know at our va it is there and it's a very robust program. and i do know that there is a lot of attention now in the nationwide being paid to family support and importance of the family. >> general scott, did your commission look into the family aspects in terms of your study? >> we looked into the family

aspects of veterans disability writ large. we looked at some of the issues surrounding the quality of life of veterans would retard and impact of their quality of life, or lack thereof on families. we made some recommendations regarding family care. i suppose some things we did may have been work for the family to act that was pastor in the last congress, i would hope so. but in terms of looking specifically at the impact of family members, on ptsd or the impact of family members for when a family member, when a member of the family discovers ptsd, we did not look into it directly. >> okay.

i will just submit that these veterans, they go into -- they volunteer. it's a family commitment. it's not just a veteran commitment, and i think we need to look deeper at the involvement of the family in the rehabilitation and their treatment. just a quick question. i heard, you know, nightmares, flashbacks. to put these folks on a track to recovery and get them ready to go back into the workforce, they've got to be able to work, which means they've got to be able to sleep. you have any idea, are there numbers out there that reflect how many of veterans with ptsd suffer from sleep apnea, or anything like that? >> well, did you want to make a comment? >> sleep disturbance is one of the most common symptoms. unless you may well have actual

data on it, but impressionistic leann clinically, the vast majority i think have sleep problems. >> is part of the hyper arousal system cluster that you see with ptsd, so it's almost i would say hallmark for most veterans who suffer from ptsd, and sometimes if we can actually address their individual symptoms, particularly in primary care, such as sleep, we can help them be more amenable to core ptsd therapy eye specialty mental health clinicians. so it's extremely important we focus on individual symptoms that are treatable. >> thank you very much. thank you i yield back. >> mr. mcnerney. >> thank you, mr. chairman. dr. seal, i appreciate your evidence-based approach to this whole subject. it's important that we have a basis for what we extend our resources on. so thank you for that hard work.

what your specific recommendations to improve retention in the mental health programs that some of these veterans -- u.k. some statistics about, you didn't get dropouts, but people who stayed in, people who didn't. what can we do or what could it be a do to help retain people in these programs? >> i think i may comment earlier about embedding more of the treatments where the veteran present, which is primary care. but i would also say that va has done a lot to invest in the va medical home, and our packings which are patient a line care teams, nurse care managers who could actually be leveraged to make reminder phone calls, conduct a difficult motivational interviewing, over the telephone, send security and the messages to veterans to remind them of appointments, do even more of that over the phone which we tried to figure out what the barriers to staying in care are.

very difficult for veterans to stay in mental health treatments because honestly, these evidence-based treatments, particularly at the beginning are not pleasant. it's not pleasant to go over and over your, many times. and we tend to lose veterans at the second or third sessions where they just can't take it anymore, and it's really, it's important that we try to retain them in treatment because once they get over the hump, recovery is definitely possible. but we need to really leverage the staff that we have at va such as our nurses, our outreach workers to really help veterans stay in treatment. whatever they are, whether it's primary care or specialty mental health treatment. >> would you say threatening to withhold disability payments would be an effective tool? >> i think that would be highly coercive. >> yes. thank you.

>> and i should add unethical, really. >> good. dr. satel, thank you. one of the things you said was the compensation before care can or may complicate treatment and recovery. i'm glad you used the me in that statement, because every individual will be different. sometimes it might help us in the case of daniel hanson who thought that might've been helpful in his case, but i've heard that some of the housing programs that require veterans to be in treatment and be clean is also a problem because it's a catch-22. if they're out on the street they can't clean up. so it be helpful for a lot of them to have housing provided, even if they are using. and so, i think it's very important to keep that in mind,

how individual this is, rather than trying to say, well, we need to withhold treatment or we need to withhold payment or a thing like that because that would be i think counterproductive in most cases or a lot of cases. >> yes. it sounds punitive and that's certain not the intent. someone earlier i believe it was congressman said something about would you force, you know, forcing people. and no, actually what came to mind, as the other were answering that, is that it seemed to me if someone, if veterans felt in enough distress to want to come forward, i think he or she had a claim, and may well, but if there was enough distress and pain to come forward and engage in that, in that process, but at the same time he thought as dr. seal said, i'm not ready to go

through desensitization, re- expressing their to are not ready to talk about my trauma, which pair that i may say sometimes i think we and those these kinds of reexperiencing therapies to aggressively. but the point is he's in distress. usually almost always the way to engage someone who is in distress, and for all kinds of -- how things that don't come what's it like being with her children again? the simplest things like that, what is your day like? you know, that's the kind of approach one might take. we are not talking about forcing someone to go to therapies that they find distressing. i wouldn't even suggest that to someone who is complete of volunteer patient, we're not going going to have you confront our participate in a kind of intervention that you felt was against your best interest in the short term. >> what we're seeing here even with our first witness this morning was treatment is most

effective when the patient is ready to accept that treatment. so it might be best for us to find a way to encourage the patient to get to that point, and to make sure that treatment is available for anyone that is at that point. >> definitely want to engage. mr. hanson said some interesting things. he mentioned the holistic approach which gets to the family situation that was earlier mentioned as opposed to a constant drumbeat of emphasis on the military experience. some patients like that sense of being back in a cohort of fellow -- some don't, and again, i guess if there's one thing that is emerging from this is that there is so much individual variation and that's always hard for policymakers to reconcile because they have to come up with a more generic kind of approach. but there's way to build room into the system. >> thank you, mr. chairman. >> thank you. >> thank you, mr. chairman.

and thank you to our panelists this morning. this issue of the veteran being ready or someone coming out of the military be ready concerns me because i think if contact is made, if someone calls a clinic or shows up in an emergency room, or talk to their primary care physician about symptoms, i think that the presumption on part of the va should be he is ready. i don't think we should wait for him to bottom out. and i'm concerned with what i'm hearing that the va doesn't create that culture, that environment where there is degrees of readiness, but we are ready at the beginning to address this issue. and the presumption should be that everyone coming home is going to suffer some variation of the ptsd. that's just the reality of what they're going through. and it seems to me that the va should be prepared for that, the

military state of mind, i'm tough, i can deal with that, we all know that is the culture of the military but the va should be ready to address the and get around it. i'm concerned based on what we heard from mr. hanson that maybe that's not the case. dr. satel, do you want to comment on that? >> when i was listening to mr. hanson i was thinking there were so many other opportunities kind of structure times. there are veterans, mental health courts. there are ways to take folks who are within the criminal justice system because that's where there's leverage, i do a lot of work with drug addicted people, so that's an actual entry point

into treatment here and he could have been essentially diverted to a drug treatment program, and then, i mean, thank goodness he didn't leave team challenge. but under somebody's diversion programs, you know, there's significant consequences for leaving, and significant rewards in addition to recovery and reintegration into society, but another reward is that your charges are dropped when you complete them. so that was one way for him to come in here another possible way, in retrospect, this all looks need i realize this at the time, it's very difficult. but sometimes people who are incredibly out of control can be civilly committed by their families. that's difficult, that can happen as well and it's very hard hit and families are reluctant. i understand it. it easy for me to say but i mean, those kinds of mechanisms are already used in the mental health system. >> it seems to be the va should

be far more prepared way out in front of all of this because of what we are seeing, the evidence is there. go ahead, dr. seal, and i have another question. >> i really appreciated your comment that i think what you're saying is you will va to be more proactive and even more aggressive in terms of chip trying to attack a mental health problem if it exists. i mean, again i go back to our model which is really almost, i don't mean to use the word passive as opposed to being aggressive, but it's passive in the sense that all new oef/oif veterans who come into primary care see a primary clear condition for 15 minutes and we literally walking over to the psychologist, they can see the ptsd psychologist for 50 minutes, whether or not they have screened positive for ptsd depression our colleges. we just assume that if you been to a word zone, you may have something to talk about. if you don't have anything to

talk about, at least you can hear about services that may be available to you when you are ready to talk. then they see the social workers. to discuss any benefits that they may be due. so that's a program that's in place so that there is no questioning, do i need this, do i not need that? they just get it when they come in. >> if we listen to mr. hanson said, he filled out a form, and based on that initial interview, that form seems pretty black and white and may depend on his outlook that day. and i think there's a bigger picture for these veterans coming home that it may not just be as simple as 10 questions on a scale of one to 10, seems like a scoping examination should go far beyond the. as you mentioned earlier, perhaps a more holistic, why do we separate mental health from the physical health? it seems to me we need to look at the entire health of that veteran, and it all works together that he is healthy. just briefly, you heard mr. hanson talk about he thought

that the va system was not as personal. he felt that the staff maybe didn't quite care as much as he found in team challenge that he felt there was no accountability. that concerns me. i don't know if we have time to get that question answered, but perhaps if you like to comment on the frequency i would appreciate it. >> again, i can only really comment from my own experience, and i feel like -- i can't speak for every clinician and every nurse and every clerk at va but i think we go the extra mile to try to reach out to veterans that are coming in. we know that every veteran who comes in, we know it wasn't easy for them to get there, that it took a lot of courage to come to va, it's not always a pleasant expensive so we welcome them when they get there. we acknowledged their military service. and we give them contact information that i get to my car. i give them my e-mail. i know i'm technically not supposed to e-mail with my veteran patients because va

policy but if that's the only way they can reach me, that's how they reach me. and i have a pretty close personal connection with most of the veterans who come and see me. that's really all i can speak for, but i know my colleagues in our clinics share that same approach and i've met clinicians from all over the country who are dedicated to serving these veterans. so it's very tricky because ptsd by its very nature and some of these other mental health problems result in the avoidance of care. it's one of the symptoms of ptsd, and so there is a bit of a dance between the patients seeking care and the providers wanting to deliver that care. and sometimes it takes a while before we can meet people where they are. and a lot of the motivational work that we can do over the phone with veterans or a lot of the education, we can give veterans can be very, very helpful in preparing them to

accept treatment. >> thank you. i yield back, mr. chairman. thank you. >> many of you in this room have heard me say often that i'm the staunchest supporter of the va system and harshest critic, and it is a zero-sum game that if one veteran falls through the crack that's what too many. i also am pleased to hear people talk of evidence-based policy and practice. anecdotal evidence, is no way to drive policy that i would tell, if i could, to the ranking member i would say what his pastor public. our leadership of this nation does the conflict that mr. hanssen was involved in would be weeks and not months. that's how we prepared for. the influx afterward is result of not preparing for the. we have been behind the eight ball for years and we're trying to get there. with that being said i certainly want to see us using the best policy, best practices to get the best treatment for all these veterans. i would tell my colleague from new york i live a few hours from the clinic that is being discussed here at st. paul.

in minneapolis. and in st. cloud, it treats 1100 inpatients per year. every 90% completion rate. we have the data that is evidence driven but if it failed for mr. hanson that's a failure we can't live with. we have to do better. my point is for us to focus on what the va does well, strengthened those, some suggestions that come up to me, pre-deployment and post-deployment assessments to get a better baseline. smart things like that. i would also ask dr. seal, the va medical center and i attend these monthly, one of them unannounced go in and talk to folks in minneapolis, they have a geriatric psychiatric team that, for 65 and older with complex age-related medicals, outpatient medical services, a staff of psychiatrist, advanced nurse specials and all the. we are approaching this from a holistic. you have the incentive system?

>> yes, we have a geriatric clinic. >> how do you measure success in your program? >> how do we measure success? not always at the end, not always at the end of treatment or a lot of the work that i do involves large national va databases where we look at diagnoses. we don't always, we aren't always able to see when a diagnosis -- >> would be safe to say the va probably has as extensive as data on practices and treatments and outcomes as anyplace in the world? would that be safe to say? >> i don't -- >> do you think it would be better than teen challenge research? >> i think -- >> she would not be mentioned these things? >> we should definitely be measuring these things and i think individual clinicians within the individual therapies do measure ptsd symptoms at the start, in the middle and at the end of treatment. do i have access to all of that

data? not necessarily because it's confidential patient data, but i think individual clinicians in va are trained in evidencing these methods which do involve methods preimposed. >> we could have a pretty good idea if i said the minneapolis va tree 15,185, could i have an idea of how many of those patients received some sort of help and we could get back to getting back to work, life satisfaction? we could gather that, could we? >> we could. i think you should definitely get the data before you decide to make changes. >> dr. satel, thank you for joining us again. i've become very for money with your work over the years. the case for coercion, tell me briefly, you have a work on that and i'm glad it was brought. i would say i have a concern would be the right word from a medical standpoint, from a human rights standpoint.

am i mischaracterizing that lets you said do not have been enlarged -- >> no, no, no. with all due respect -- >> explain to me the case for coercion. research-based case for coercion. >> that was written about, that was something i wrote a while ago and it had to do with addiction. that was the context mentioned earlier. so, we're talking about people basically violated the law. it's a different population. >> are you applying this, decided you didn't put up the idea of possibly withholding benefits as used in some ways? is this not coercion? is your policy what you're asking for on how we get people into this, is it not coercion? am i mischaracterizing that? >> i'm actually setting forth various kind of options. one could be that before we call someone disabled, before we call them disabled, they have to be experienced some good quality

treatment, and that, there's a whole lecture on what good-quality treatment is. it sounds like you are doing a great job, but i'm talking about at the point which we call someone disabled. that's very different from not giving someone the kind of financial assistance they need, and provide, you know, making the kind of help that the need of able to them. so we are not withholding. we are just changing the conceptualization of when a disability claim itself, when the whole identity of being a disabled person would kick in. >> we deal with slippery slope issues all the time. what would stop this from crossing over into the physical issue? the issue we're discussing here is mental health -- the chairman spot with increase, we had to bring the va in here and tell them it has now been incorporated into law and those types of things. how would we not slip into this and say, you know, we are going to wait to see first if you can go back to work before we help

you with that when you got shot in the leg. >> we are leaving this event at this point as the usn is about to gavel in. senators will spend the morning and early afternoon on general speeches. the economic development bill senate have been working on has been set aside. "congressional quarterly" reporting senators could vote this afternoon on cia chief leon panetta to head the defense department. and now live senate coverage you on c-span2 gracious god, from whom all blessings flow, we lift our hearts to you in prayer not because we're perfect, but because we're flawed human beings. in need of you. help us to find your judging truth, your cleansing pardon,

and your comforting promise. today as the members of this body listen, study, ponder, and discuss. give them special wisdom to sift and sort and filter the voices so that out of debate and decision may come truth, justice, and righteousness. lord, use our senators so that your will may be done on earth as it is in heaven. we pray in your sacred name. amen.

the presiding officer: join me in reciting the pledge. of al legiance to the flag. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. the presiding officer: the clerk will read a communication to the senate. the clerk: washington d.c., june 15, 2011. to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable jon tester, a senator from the state of montana, to perform the duties of the chair. signed: daniel k. inouye, president pro tempore. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: following leader remarks the senate will be in morning business until 2:00 p.m. today with the first hour equally divided and controlled

-rblgs the republicans will -- the republicans will control the first half. the majority will control the second half. we continue to work through amendments on s. 782. mr. president, americans have been very clear about where they stand on the republicans' budget proposal. they reject it soundly, and for many reasons. but the most glaring is the effort to change medicare as we know it. no one -- a successful program that saved seniors for decades. millions of them. their program is nothing more than an ideological program to shift the burden to seniors, an effort to put the insurance companies between senior patients and their doctors. with all due respect, the ranking member of the budget committee here in the united states senate pointing the finger at democrats as he has done will not erase the fact that they plan to end the medicare program as we know it and like it. democrats, republicans and independents feel the same way.

no amount of political distortions or distractions will change that. only when republicans agree to take cuts to medicare off the table can we have a serious discussion about how we can move forward on our battle to decrease the deficit. republicans claim only sacrifice from seniors will balance the budget. we disagree. yet they protect tax breaks for millionaires and billionaires. they protect billions of dollars in taxpayer-funded handouts to oil companies, making record profits. the republican plan will put insurance company bureaucrats between seniors and their doctors. it would force each senior, for example, to pay $6,400 more each year for health care. breaking our promise to seniors while wealthy oil companies and billionaires get a pass is simply too high a price to pay. we need to strengthen medicare for the millions of seniors who count on it every day and preserve it for our children and grandchildren, not cut senior benefits. mr. president, i'm going to note

the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. mcconnell: mr. president? the presiding officer: the republican leader. mr. mcconnell: i ask further proceedings under the quorum call be dispensed with. the presiding officer: without objection. mr. mcconnell: mr. president, over the past few weeks americans have gotten what seems like a daily dose of bad news about the state of the economy, whether it's more joblessness, threats from ratings agencies, the price of gasoline, goods and housing, or a slowdown in manufacturing; people are finding very little reason for optimism. and they're getting little comfort from an administration that seems more interested in deflecting the bad news than

facing up to it. amidst the onslaught of bad news last week, president obama's message was that we had hit some bumps in the road. we had hit some bumps in the road and that people need to be patient in the face of what he called economic headwinds. he even joked about the wildly mistaken predictions he and others at the white house made a couple of years back about the job-creating potential of the stimulus. well, i don't think the 14 million americans who are looking for jobs right now find any of this very funny. i don't think that the 23% of americans who now owe more on their mortgages than their homes are worth are laughing about their predicament. i don't think recent college graduates out there who are burdened with tens of thousands of dollars in student loan debt and who can't find a job are

amused that the stimulus turned toubt a failure -- turned out to be a failure. in fact, i think americans are deeply troubled by the fact that an administration which claims to be concerned about creating jobs has spent the better part of the past two and a half years, the better part of the past two and a half years pushing policies that seem like they were designed to destroy jobs instead. indeed, i think there is a growing consensus out there that far from improving the economy, the president has made it worse. the facts speak for themselves. the day the president took office, 12 million americans were out of work. today nearly 14 million americans are out of work. that's a 17% increase in the unemployment rate under president obama. so employment is clearly worse.

gas prices have nearly doubled. when the president came into office, the average price of a gallon of gas in the country was $1.85. today it's $3.69. so gas prices have gotten worse. the national debt has reached crisis levels. in just the last two years the debt has gone from $10.6 trillion to $14.3 trillion, a 35% increase from when the president was sworn into office. and his own budget projects that it will only continue to grow. so, mr. president, the debt is far worse. health insurance premiums have gone up. for more than a year the president devoted what seemed like every waking moment to a health care proposal that he said would lower health insurance premiums by as much as $2,500. instead h health premiums for working families continue to rise.

and the nonpartisan congressional budget office says they will continue to grow by as much as $2,100 per year. so health insurance costs have gotten worse. home values continue to plummet too. in my state of kentucky, home prices have fallen about 7% in the last year while new home construction is down almost 15%. i've got constituents with excellent credit telling me they can't get a mortgage because of new lending rules that have made it hard even for people who worked for years and built a stellar credit rating to even get a loan. nationally, home values have gone down 12% since inauguration day, so home values have gotten worse too. driving down the equity people have built up over many years. when it comes to policy, the president is fond of dividing the world into two camps. in his view, those who disagree with him are on the wrong side

of history. those who agree are on the right side. well, at this point i think most americans would agree that if this is the right side of history, they're not interested. they'd rather have their jobs back. at this point i think it's safe to say that the patience of the american people has run out. administration officials made a lot of promises of a brighter future. they have had their chance to deliver. americans don't have infinite patience. they don't want to be told to just wait a little longer when all the evidence shows that their circumstances and their prospects are only getting worse. they want a change in direction. you know, one of the liberal think tanks in town recently issued a press release that i think embodies the disconnect between democrats in washington and the experience of most people outside of washington.

in the face of all the bad economic news we've been getting, this particular think tank announced that it had ten charts which purported to show that contrary to the claims of some, the u.s. is actually a low tax country. never mind the fact that we have the second-highest corporate tax rate in the world. never mind the fact that nearly 14 million americans are out of work. never mind the fact that the time it takes out-of-work americans to find a new job is now longer than it was during the great depression and that since the housing crisis began, average home values have fallen more dramatically than they did even during the great depression. never mind all that. these guys have ten charts they want to show you that prove government should take more money out of the hands of taxpayers so they can spend it themselves. i think this is all you need to know about the democratic

approach to the economy. it never seems to change. take almost any major economic indicator you want. americans are worse off than they were in 2009. it's time democrats wake up to this fact. it's time they do something to solve these problems and help the people right in front of them. mr. president, i yield the floor. the presiding officer: under the previous order, the leadership time is reserved. under the previous order, the senate will be in a period of morning business until 2:00 p.m. with senators permitted to speak therein for up to ten minutes each, with the first hour equally divided and controlled between the two leaders or their designees, with the republicans controlling the first 30 minutes and the majority controlling the next 30 minutes. mr. mcconnell: i suggest the absence of a quorum. the presiding officer: the clerk will call the roll.

quorum call:

mr. thune: i would ask the quorum call be dispensed with. the presiding officer: without objection. mr. thune: these past few weeks, i have been coming to the senate floor to talk about the size and scope of this nation's fiscal problem. it has been said this is the biggest crisis our nation has ever faced. i believe that's true. i talk about how the tremendous growth of government has limited the ability of small business to create jobs. i've noted that the severe and dramatic cuts that medicare and medicaid and social security will face if we do not act now to reform those programs now.

i have also pointed out how these draconian cuts would need to be paired with painful, job-crushing tax hikes. simultaneously, the interest that we pay on that debt will take up an ever-increasing share of our revenue. in fact, it's already been noted that in a few short years, the interest on the debt alone would exceed the amount that we spend on national security. in other words, we would spend more paying for the amount of money we borrow in the form of interest than we spend defending the country. at some point, bondholders are going to recognize that we don't have an ability to pay out these demands and they will demand increasingly higher interest rates. this in turn sends our interest rates even higher, a vicious spiral. however, what i'd like to focus on today, mr. president, is to talk about how none of this is necessary. so how do we prevent this from happening? i think the solutions that we -- that we need fall really into three broad categories. we need reforms to our budget

processes that include, one, a balanced budget amendment to the constitution. we need caps on overall and discretionary spending. and we need entitlement reform. in the 1990's, the senate was within just one vote of passing a balanced budget amendment to the constitution. and i can't help but think, mr. president, just how different our country's fiscal situation would be if that amendment had been approved. we have two now different balanced budget amendment proposals put forward this year. i cosponsored both of them. i had the opportunity to lead a working group of my fellow republican senators to discuss these proposals and to help find the best parts of each. from those discussions and others, we were able to come together with the hatch-lee balanced budget amendment of which every single member of the republican conference is a cosponsor. this important amendment requires the budget to be balanced every year, except for when there is a declared war.

a supermajority would be required to waive this provision. this amendment puts the emphasis on controlling spending, which is the real cause of our debt and deficits. it requires supermajorities to raise taxes and it prevents spending from exceeding 18% of our g.d.p. 18% of our entire national output, which has been the historical level of taxation for our country. not only do we need to balance our budget, mr. president, but we need to ensure that every dollar is being spent in the most efficient way possible. we need to be honest about the cost of this spending and to create processes that will prevent wasteful, unnecessary and excessive spending. in order to do this, we need a number of budget reforms in addition to the balanced budget amendment. now, i have introduced a deficit reduction and budget reform act, and this has a number of reforms to the budget process that we use today. the bill reforms the paygo rules

to prevent the double-counting gimmicks that get used around here all too frequently and it makes the federal budget a binding joint resolution signed into law by the president, something that doesn't happen today with our budget. it moves us into a by annual -- into a biannual budget time line that moves us for oversight. we are supposed to do a budget every year. we haven't done one now for i think 777 days, so that -- the motion that we do a budget every year may be somewhat an antiquated one, but we are supposed to do a budget every single year. because of that, we spend an awful lot of time going through the budget cross, doing all the appropriation bills, and it doesn't allow very much time for oversight, which is a function that i think we have a responsibility to do. and so if you went to a biannual budget, in other words, if you did a budget every other year, if you did the spending and the budget and the appropriation bills in the odd-numbered years, in the even-numbered years when

people have to go home to run for re-election, we could actually focus on oversight. we could look for ways not to spend money but ways to save money. i have been a big advocate of biannual budgeting, doing a budget every other year, two-year budgeting for some time. a number of states do it that way. i think it's important that we make that reform so that we have the appropriate time to do the level of oversight that is required and is so, i think, desperately missing around here today, which is why we end up having, i think, so many government agencies with so much duplication, so much redundancy and so much overlap that needs needs -- leads to wasteful spending on behalf of the american taxpayers. and so the other thing that it would do, my budget reforms, it would create a legislative line-item veto. my governor in south dakota has that, and i believe the president should, too. in fact, i think most governors across this country have some sort of mechanism that allows them to veto extraneous spending

measures. i believe the president ought to have that power and we need to be -- it needs to be done in a way, of course, that's consistent with the constitution and a legislative line-item veto would meet that test. it prevents the abuse of emergency spending designation which is have been used to pass hundreds of billions of dollars in deficit spending since the last time we passed a budget resolution. and it creates a new class act trigger so that if that program is not solvent over the -- to make sure that that program is solvent over the 75-year time frame. now, i think most of my colleagues know that the class act is a new long-term care entitlement program that was enacted as part of the health care reform bill last year. it, like so many other government programs, relies upon premiums that will be paid in the early years, which lead to actually show revenues coming into the treasury, which are then counted and used to pay for other things. in this case, the health care bill, but at some point in the future when the demands come for

those benefits that people have subscribed for, it becomes a liability, and because the -- the funds, the revenues that have come in to that program in the early years have already been spent, again, it leads to more and more borrowing, and that is what the congressional budget office has said would happen with the class act. we no make sure if that program is going to stay on the books -- and by the way, i have a piece of legislation that would repeal it because i think it is really bad policy and will put our country even deeper in the fiscal hole. that being said, if it's going to stay on the books it ought to have a mechanism whereby we ensure that program is solvent over the 75-year period time frame. my legislation would do that. likewise, it modifies the medicare cost containment trigger to have honest accounting with respect to revenues and savings in the new health care bill. and it updates the credit reform act to score the purchases of debt, stock, equity, and capital

using a discount rate that incorporates market risk. whenever the government gets in the business of acquiring debt, stock, equity, those sorts of things -- and that hasn't happened as we know in the last few years -- it needs to be accounted for honestly by using real discount rates that make market risks part of that calculation. today that isn't necessarily the indicate ka*eus. it also creates a standing joint committee of congress for joint deficit reduction. it might interest my colleagues to know that sometimes we forget about this around here, but we have 26 committees in congress and subcommittees that spend tax dollars. we don't have one that focuses on saving tax dollars. we need a committee that is exclusively committed to reducing the cost of spending, to saving tax dollars as opposed to spending them. 26 committees and subcommittees around here that spend money.

it's time we have one that saved money. the joint committee would be responsible for producing a bill that cut the deficit by at least 10% every budget cycle, and to do it without raising taxes. it would be a standing committee that would continue to fight government spending, issue recommendations to cut spending by at least 1% even in years when the budget is balanced. it's been a long time since we've seen that around here. that probably won't happen in the forseeable future. i certainly hope it does. my legislation would require even in years the budget is balanced that we be looking for ways to cut spending. these recommendations would be assured of an up-or-down vote in congress. the committee would make its recommendation each year, and my legislation would require expedited consideration on the senate floor, in other words, to ensure it gets an up-or-down vote and do the languish somewhere like so many reports that come out of various committees. this committee would actually have the authority to put a product out on the floor of the senate and to ensure that it gets a vote.

finally, what my bill would do, mr. president, is freeze and cap spending. the third action we need to take in order to get spending under control. this bill would institute a ten-year spending freeze at 2008 levels adjusted for inflation. after all, between 2008 and 2010, non-defense discretionary spending increased by 24% while inflation in the overall economy was just over 2%. so the federal government in the last couple of years, between 2008 and 2010, was spending at literally over ten times the rate of inflation. how can you go to the american taxpayer with a straight face and explain that? so we need to go back to those 2008 levels and freeze it there, cap it there and then allow for adjustments for inflation. but let's go back and negate this 24% increase that we've seen just in the last couple of years. the recent continuing resolution that was passed by congress

started to put downward pressure on these accounts, but more needs to be done. my colleagues, senators corker and mccaskill introduced what they call the cap act which would put spending on a downward glide path so we don't spend more than our historical average of 20.6% of g.d.p. the last 40 years, mr. president, we have averaged spending on the federal government has averaged 20.6% of our total economy. that represents all of federal spending. that doesn't represent state and local government spending. but federal spending percentagewise on average for the past 40 years has equaled 20.6% of our entire economic output. this year we are in the 24% to 25% range. we have gone from spending a fifth of our entire economy on the federal government to spending about a fourth of our entire economy on the government. that, to me, is something that needs to be reined in.

we've been a huge ramp up in spending as a percentage of our entire economy. what that means is that the private economy as a percentage of our whole economy is getting smaller, and the government spending, the government component of that is getting larger. we need to get that back on a more historical and what should be realistic course. so there are at least three different possible proposals to cap spending. the 18% included in the constitutional amendment, the cap act which i just mentioned, and my own proposal to cap discretionary spending. these caps are necessary to signal to the markets that we are serious about cutting spending. finally, mr. president, we need entitlement reform. the cap act and the 18% cap would both force us to deal with entitlements. i am heartened by the budget working group that's being led by vice president biden and that they are considering some entitlement reforms. and i hope that they can produce a product that actually will

tackle entitlements and we really need to have at the end of the day the president leading on this. this group that's been put together, i hope, as i said, produce a result that will take us down a path toward tackling runaway entitlement programs. but we've got to have at the end of the day, for any of this to be accomplished, for any of this to get signed or get enacted, we have to have the president stepping in and providing leadership. and so far, mr. president, we have not seen that. the president in his budget that he submitted to congress and the subsequent budget speech he made has done little, if anything, to deal with the issue of entitlement reform. frankly, you cannot -- you cannot deal with the fiscal problems this country faces, the challenges that we face or the deep hole that we're in when it comes to getting on a more sustainable course for the future without taking on entitlement reform. the president needs to be explaining to americans the need for entitlement reform and showing us what his plan is to

save social security, medicare and medicaid. not simply getting out and demagoguing chairman ryan's budget and kicking the can farther down the road. we know that these entitlements already represent $61.6 trillion in unfunded liabilities. there is no more road. we have kicked the can as far as we can. it is now time for us to face the reality that we have to deal with this, and we can't afford the luxury of waiting any longer. it is clear that action needs to be taken. and if the president were to step up to the plate, i think we'd have a real chance to enact substantial entitlement reforms that could preserve the important role that these programs play. so enacting these three different prongs or these three different approaches, one dealing with budget reforms that include a balanced budget amendment being the first component; spending caps being the second component on discretionary and overall

spending; and entitlement reform, those are not going to be easy things to do. we've been on auto pilot around here for a long time. what that is has gotten us is deeper and deeper into a fiscal hole that today we are at $14 trillion in debt, meaning that we're going to have to raise the debt limit here in the very near future, and growing by the day. and the amount that it grows by the day, interestingly enough, is $4 billion. we will borrow between this time and 10:40 tomorrow another $4 billion that we will add to our children's debt. now, that represents more than we spend in my home state of south dakota for an entire year. $4 billion, the amount that we borrow every single day at the federal level, succeeds the amendment -- exceeds the amount that the state of south dakota spends in an entire year. that is the dimension of the problem we are dealing with. there are three really important numbers that i think people need

to focus on to just reap mind ourselves -- remind ourselves how critical it is that we act. one is 42. that's the cents out of every dollar that we borrow. 42 cents out of every dollar that this government borrows today -- that this government spends today is borrowed. that is a staggering statistic. the other number is 93. 93 is the number now that represents the percentage of our entire economic output that is represented by our gross debt. in other words, our debt to g.d.p., our debt to total economic output ratio is 93%. that's the danger zone. research, historical research has shown and demonstrated that when you get a debt to g.d.p. ratio that exceeds 90% that you are losing one percentage point of economic growth every single year. one percentage point of economic growth translates into a million lost jobs. so every year that we continue on this path of sustaining this level of debt as a percentage of

our entire economic output, we are bleeding a million jobs in our economy. it's costing us one percentage point of economic growth. that is a very real and immediate impact from the amount of spending and the amount of debt that we have. and the final number that i think is important for people to understand too, and that's the number i mentioned earlier, mr. president, and that is the 777 number because that's the number of days it's been since congress has passed a budget. now, i know that it's very hard around here, particularly in circumstances like we're in, to find consensus on a path forward when it comes to a budget. but we have a responsibility to the american taxpayers when we are spending literally $3.7 trillion to $3.8 trillion every single year to at least let them know how we're going to spend their money. we haven't done a budget here in 777 days. now, i serve on the budget committee. we have not had a markup.

there is no indication that we will have a markup. there is no indication that we're going to do a budget. we've already blown past all the deadlines that the law requires when it comes to doing a budget. we didn't do a budget in the last congress. and i think what that does is it makes it even more complicated to address these issues. because if you don't have an overall framework, if you don't have an understanding of what it's going to take to get our books back in order, then it's going to be really, really difficult. sometimes around here we don't have enough teeth in the laws that we have when it comes to budgeting. we don't have enough format mechanisms which are things the budget reforming are trying to cure. even with that, you at least have to have a plan. you at least have to have a blueprint, a path for how you are going to spend $3.7 trillion of the american taxpayers money. and so i would urge my colleagues, the majority, to put forward a budget.

at least let's debate it. let's talk about priorities. let's have a debate. let's debate amendments. but let's do a -- either do a budget or let's reform the budget process along the lines of what i've suggested so that we get a process in place that enables us to make some headway and to make some progress toward dealing with this runaway debt, these runaway deficits that are just going to crush, not only crush our economy in the near term, but put an unfair burden on future generations of americans. right now the thing that most americans are worried about: spending, debt, jobs and the economy. and they're all connected. the level of spending and debt is something that needs to be gotten under control to get the economy growing and prospering again so you don't have the federal government out there competing with the private economy when it comes to capital. small businesses need capital to invest, to create jobs. when the government is crowding that out, it makes it more difficult. there are so many adverse indications, economic indications from the debt levels that we are sustaining today, it is going to make it increasingly

difficult the longer we stay deeper and deeper in the red for this economy to recover and grow. so that's fundamental to all this. when it comes to jobs and the economy, we also have to have policies that encourage economic growth. and i know that the president has -- talks a lot about jobs and the economy. he certainly is he toreically, at least saying the right things out there but you've got to have actions that are consistent with the rhetoric. and if you look at the record, the president's record, we haven't seen that. the reason we haven't seen that is because the policies are all adverse to economic growth and job creation, whether it's regulations coming out of agencies, whether it's the new mandates imposed by the health care reform bill, whether it's the out-of-control spending and debt and no attempt to address the long-term challenges that we face there, particularly entitlement reform, whether it's the new taxes that have been imposed through the legislation that's been enacted since this president's come into office, but if you look at the economic

record, you look at unemployed americans since this president took office, we have almost two million more unemployed americans. the unemployment rate has gone up 17%. fuel prices, which impact everybody's pocketbook in this country, since this president has took office have gone up by over 100%. over 100% increase in the price per gallon of gasoline since this president took office. the federal debt has gone up 35%. the debt per person in this country has gone up $11,000 per person. that's the amount that the debt has increased since this president took office. food stamp recipients are up 39%. health insurance premiums, despite all the promises about what health care reform would do to lower insurance premiums, health insurance premiums have gone up 19% since this president took office. the only thing that has gone down, mr. president, since he took office is home values. home values are down 12%. so that is the economic record.

that's the composite record. of course, we can all say things, but we have to be judged by what we do. you can't judge people by what they say. you have to judge them by what they do. and i hope that the president will decide that it is time for him and for his administration and for his leadership here to focus on policies that will be conducive to economic growth, that will enable that rather than make it more expensive and more difficult to create jobs, which is what the policies that are being employed by this administration are doing today. as i said, that applies to so many areas. developing domestic energy resources so we can get more american supply of energy and start driving that price down, so many areas are off-limits, even more have gone off-limits since this president took office. it means getting trade bills enacted. we've heard now for several years the president talk about we need to pass the colombia, panama and south korea free trade agreements and yet they

languish, they haven't been submitted to us. we're ready to act. we have said repeatedly these are important to our economy. i have used this example on the floor before, but one brief data point for agriculture. i represent an agricultural state so we're always looking for opportunities to export. in wheat, corn and soybean exports, we had an 81% share of the colombia market in wheat, southern and soybeans in 2008. -- corn and soybeans in 2008. in 2010, that had dropped to 20%. we have been literally locked out of that market because this free trade agreement has languished in congress and as a consequence other countries have stepped in to fill the void. so now you have the canadians, the europeans, the australians stepping in and picking up the slack, and we continue to lose and erode more and more market share, which means more and more lost jobs in the american economy. so it's about trade policies, tax policies, energy policies,

regulatory policies and spending and debt. those are the things, mr. president, that in my view will get this economy back on track, start creating jobs, create a better and brighter and more prosperous future for future generations of americans. unfortunately, the policies being employed by this administration are making it worse, and at least according to this economic record much, much worse. we can do better. we should do better by the american people, and i hope that we will find the political will here to do that. mr. president, i yield the floor. the presiding officer: the senator from connecticut. mr. lieberman: i thank the chair, mr. president. i rise to speak today about the fiscal crisis facing our country and specifically the dire financial situation of medicare, which is a program that matters so much to tens of millions of senior americans, but also adds

so much to our national debt. and i want to talk about some ideas that i have about how we might effectively deal with this problem, in medicare particularly, without doing away with the medicare program because i believe in it. if i can start on a broader level, briefly, it's hard to find anybody here in congress in any party who doesn't acknowledge that our federal government is hurtling toward the edge of a financial cliff. we're now running again deficits in this year of over over $1 trillion. that means we're spending spending $1 trillion more than we're taking in, so we have to borrow that money, and at some point we're going to reach a level of borrowing that is

unsustainable. one of the great -- and will send us, our economy hurtling down, will bring us into another great recession, will compromise our ability to provide the security and services to the people of our country, that it is our responsibility to provide. and to avoid that really horrific result, we have got to show some responsibility and work across party lines to get some things done. none of this is easy, so you get -- almost everybody will say we have got a terrible financial problem here with the government debt, deficit, but when you get to the solutions, there has been an outbreak of what i call federal government nimby-ism. everybody talks about at the

federal government or state or local level, not in my back yard. this is a great program or great facility, but not in my neighborhood. in the federal government budget criesm we're in, nimby-ism -- crisis we're in, nimby-ism seems to be not my favorite tax credit. you can cut that other stuff but not what i'm in favor of. and so we have got one group saying no tax increases whatsoever, even indirect, through the elimination of tax credits, which are spending money -- and they can be as wasteful as -- tax credit can be as wasteful an expenditure of the taxpayers' money as a wasteful spending program can be. on the other side, we have people saying oh, not my program, you can't touch it, you can't try to make it more efficient. it's just too good or too politically popular or whatever. and if we keep going down that

road, we're not going to get anything done. the main hope of the result over the next couple of months is a bipartisan, bicameral leadership group that has been presided over by vice president biden. i think any time any of us come out and say no, whatever the agreement is, you can't do this, you can't have a tax increase of any kind, you can't eliminate wasteful tax credits. on the other side, people say you can't touch medicare, for instance. it, one, shackles the hands of vice president biden as he tries to solve this problem, and it also means more generally that we're not fulfilling our responsibility. and, you know, that's the case with medicare. the fact is that those who say

you can't do anything with medicare, we just won't support it, are not doing a favor to the medicare program. congressman ryan, paul ryan, chairman ryan of the house put forth his own budget, including a medicare reform program. i said when deit that i wanted to look at it in more detail, but i gave him the credit for having the guts to put something so comprehensive out because it's going to take that kind of guts by all of us to save our great country from going over the edge of the cliff, from going into permanent decline, for making it possible for our children and grandchildren and beyond to have the opportunities that we have had. when i looked at the ryan plan particularly on medicare, i decided i wasn't for it. when it came up here in the senate, i voted against it. that was the case generally when it came up here in the senate in the vote on the ryan budget. but you can't just stop there. and say no, which is a popular

vote, on a medicare reform proposal. i think any of us responsibly have to then come forward with our own ideas. and that's why last week i indicated in a newspaper op-ed column that i would be putting some proposals forward that will save medicare, that will protect medicare as a government program of health insurance for senior americans but that will change the program, because anybody who tells you oh, paul ryan is going to kill medicare as we know it, there's another way to kill medicare as we know it, which is to do nothing to try to save it because we cannot save medicare as it exists today. tell you that the average -- here are going to be a couple of statistics. 2010, the medicare program cost cost $523 billion. the estimates that i've seen are

consensus, not extreme estimates, that within the next ten years, that number will double, double to over over $1 trillion for medicare. where are we going to get the money to pay for that? that's going to add to the national deficit and the national debt. part of what's happening is that the baby boomers are coming of age into medicare eligibility. 15 million in the coming years. coming into this program. give you another general statistic. all the studies i've seen show -- most people don't appreciate this -- that if i can say the average medicare participant over the lifetime will actually cost the system in benefits three times what we put in through premiums withdrawals,

et cetera. so this program is on an unsustainable course, and i think if you want to save medicare, you've got to be willing to change it. you can't say don't touch medicare. i must say i'm disappointed when i hear people say that. so here are some of the ideas that -- that i'm going to -- that i'm working on legislation to propose. the plan that i outlined last week and i'm putting into legislation will extend the solvency for part-a, the big program for hospital care. it will lower the federal government's financial commitments to the part-b program for doctor services. and most important, it will keep the medicare program alive and serving america's senior citizens for at least 20 years and when we get it estimated probably by a lot more.

a lot of the proposals that i have made -- and i have five key parts of it -- are similar to ones that have been made earlier and that the congressional budget office has made estimates on. my guess, applying existing c.b.o. estimates to the ideas that i have put forward is that this -- they will save save $250 billion in the first ten years and extend the life of the program by at least 20 years. and that's 20 more years in which american seniors can depend on medicare to help them pay their health care bills in their senior years. so -- so here's some of what i'm proposing. one -- and it's controversial, but they are all controversial. you can't save medicare without doing some things that make some

people unhappy. i'm proposing to raise the eligibility age of medicare from 65 to 67, beginning in 2014, by two months every year until it reaches 67 years in 2025. that would put it on the same course that social security is on now to go up to 67. that means if you turn 65 in 2014, you will have to wait an additional 60 days before you become eligible for medicare, but in my opinion, that's a small price to pay for the guarantee that you're going to have medicare to take care of your health insurance, health costs for the rest of your senior years. and the reason for this change being necessary is factual. when the medicare program began in the mid 1960's, the average life span of an american was a little less than 70 years. today, the average life span is 78. thank god. but that means that people are

obviously living longer. part of why they are living longer iser they are -- longer is they are getting better health care, but that fact, that wonderful fact explains why the average recipient takes three times as much out of the medicare system as the -- as they put in. give you another number that says this in a different way. in 1965, there were about 4.6 active workers for every medicare enrollee person in the program as a senior. 2005, that went down to 3.8. the medicare actuaries tell us by 2050, that will drop to 2.2 workers for everybody on medicare at that time, and that means that the burden on those 2.2 workers is going to be too high. the program -- the current math is therefore unsustainable and it's why we have to change the

eligibility age. according to the congressional budget office, doing so, 65 to 67, will save $125 billion over ten years. that's a substantial savings which will contribute, remember, that money will contribute to keeping the program overall viable, paying bills for seniors. the other thing to say, and i will just say this quickly, for those who fear what will happen to those seniors between 65 and 67 as they wait, some obviously will have their own health insurance, but we did pass health care reform, and that's going to be there to cover those people through the -- through the health care exchanges. second, i'm proposing that we reform the complex medicare benefit structure, which is wasteful, misunderstood, particularly by the beneficiaries and a lot of the providers and prone to

overutilization and fraud. that is, taking more, prescribing more health services because you don't pay for it, medicare does, but we all pay for it. the medicare benefit structure is so confusing and so maligned with various deductibles, co-pays, cost sharing, caps, fees, forms and limits that you would be hard pressed to find a medicare enrollee that really understands how their insurance coverage works. as a result, there is enormous waste, excess utilization that services being paid for by the medicare program that are really not needed for the health of the individual. and that, again, means more cost for the taxpayers. we can fix these problems, i think, by implementing a sin tkpwepl combined part-a and part-b deductible. and if we choose, we can also do something new, which is create a

maximum out-of-pocket benefit that will give seniors peace of mind. in other words, that they would only be required to pay up to a certain amount out of their pocket every year. it guarantees them that if they have a real serious illness, long-term hospitalization, they're not going to be forced into poverty or bankruptcy. incidentally, that proposal was part of the bowles-simpson report, and it's a good one. third, continuing's time -- i think it's time to reform the premium structure. when the medicare was implemented, the premiums paid by the beneficiaries supported 50% of the cost of the program. in fact, when president johnson signed the medicare law into law, he noted that this equal contribution -- 50% from government, 50% from the insured -- was a critical part of the program. and he said -- and i quote -- "and under a separate plan, when

you are 65, you may be covered for medical and surgical fees whether you are in or out of the hospital. you will pay $3 per month after you are 65, and the government will contribute an equal amount." end quote. 50 hr-rbs 50. un -- 50-50. unfortunately today, as a result of acts of congress of various kinds, well intentioned medicare enrollee premiums support only 25% of the cost of the program, half of what they were intended to when president johnson signed this extraordinarily progressive and beneficial law into effect. we make up the difference from funds taken out of our federal budget, general revenues. that's part of the, part of why medicare contributes to the exploding national deficits annually and long-term debt. so i'm going to propose that we raise premiums for all new

enrollees in part-b, which is the part that covers doctors' expenses, starting in 2014, so they pay for 35% of the program cost instead of 25%. that will result in around a $40 increase in premiums. and the fact is that there is some indexing based on income in the, in the part-b and part-d programs. and, therefore, under the current law the increase from 25% to 35% will be paid more by people of higher income. i know asking anybody to pay more money for anything is not popular, but it's needed if we're to address the stranglehold that medicare puts on our annual budget and if we're to avoid something even more unpopular, which is the demise of the medicare program as we know it. fourth, i think we need to reform the way medigap policies work. medigap policies are insurance policies that cover the gaps in

a senior's medicare coverage. they're designed to pay an enrollee's co-pays and deductibles so he or she won't be liable for a big hospital bill if they ever get sick. but study after study have found that the medicare enrollees who have a comprehensive medigap plan that pays all the deductible and all of the co-pay so the individual doesn't pay anything, uses as much as 25% more service than those with the traditional medicare program. and that's because they don't have any impact on themselves for the utilization of services. again, who pays for that extra utilization of services? not the individual medicare enrollee. the taxpayer, and it's not fair. tpeufbgt -- be fifth, we've got to increase revenues coming into the medicare program. we can't save it by making changes in the premium structure. i'm going to propose that

higher-income americans -- in this case i'll define it as people making over $250,000 a year -- contribute an additional 1% of every $1 of income over $250,000 to save medicare as we know it. that's the outline of my plan, mr. president. i wanted to come and describe it to my colleagues. raise the eligibility age, charge a more financially sound premium, address overutilization and waste and fraud, and develop a more reliable funding stream so that we can save medicare, which is a great program, and which we won't save unless we take some tough decisions. i said earlier that i think this proposal will save at least $250 billion in the first decade and keep the program alive for 20 years. i was really encouraged that the very respected committee for a

responsible federal budget said after i disclosed this plan last week that they believe it would save as much as $325 billion over the next decade and reduce spending even more in following decades. i offer these ideas as a starting point and a discussion that we've got to have about how we can both extend the solvency and life of medicare for the seniors who depend on it and reduce our national deficit and debt, which we will not do unless we reduce the drain on our national treasury that the medicare program now represents. i'm going to be drafting this legislation. i'm going to circulate it to my colleagues. i hope it's of some assistance to vice president biden and the leadership group that's working with him as they prepare proposals to get america's ship of state back into fiscal

balance. i know that all of these are, are full of risk, political risk. but the refusal of different parts of congress, different parties to either cut spending on the one hand or raise taxes on the other is exactly why we're in the fiscal mess we're in now. and the more we wait to deal with it, the harder it's going to be. at some point there's going to be such a disaster that we're both going to have to impose draconian cuts in spending and tax increases, and none of us want to do that. the way to avoid that moment is to do it now in a methodical and sequenced longer-term way. the effect is that unless we take risks together, the great losers -- and those risks have to be across party lines. this has to be a moment when we say to each other across party

lines, these are tough votes. i can demagogue this vote. i can go after you in the next election based on this vote. but i'm pleading with you to cast this vote, and i'll cast one that's risky too politically so that we can do something good for the country. because if we don't turn away from partisanship and turn toward shared responsibility, the big losers are going to be our great country and the wonderful people who elected us, sent us here to lead it. i thank the chair. i yield the floor, and i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: a very

negative impact on our fragile economic recovery. also, in rural states like vermont and montana and other rural states, it is wreaking

real hardship on working people who in many cases drive long distances to work. in vermont, certainly, it is not uncommon for people to be driving 50 miles to their job and 50 miles back. when the price of gas gets to be be $3.80 a gallon or $4 a gallon, it really hurts. and when wages are stagnant, when many people have seen a decline in their paychecks, high gas prices have just taken another chunk out of their limited income. it's something that as a congress, we have got to address. the price of oil today, while declining somewhat in recent weeks, is still over $97 a barrel, and in vermont, it is over $3.80 a gallon at the pump. now, the theory behind the setting of oil prices that we learned in high school is that oil prices are set by supply and

demand. when there is limited supply and a lot of demand, oil prices go up. when there is a lot of supply and limited demand, oil prices should go down. so let's be clear. the fact of the matter is that today there is more supply than there were two years ago, that today there is less demand than there was two years ago. therefore, oil prices should be substantially lower than was the case two years ago. the fact, however, is just the opposite. in vermont today, gas prices are are $3.80 a gallon. two years ago, they were approximately $2.44 a gallon. so the explanation of supply and demand in terms of why oil prices have soared just doesn't carry any weight. mr. president, while we cannot ignore the fact that big oil companies have been gouging consumers at the pump for years

and have made almost $1 trillion in profits over the past decade, there is mounting evidence that the increased price of gasoline and oil has nothing to do with supply and demand and everything to do with wall street speculators who are dominating the oil futures market and driving prices up, up and up. ten years ago, speculators only controlled about 30% of that market. today, wall street speculators control over 80%, over 80% of the oil futures market, and many of them will never use one drop of that oil. so we're not talking about airlines that use gas and oil. we're not talking about trucking companies, we're not talking about home heating companies. we're talking about speculators

whose only function in this entire process is to make as much money as they can by raising prices and then selling. now, this is not just senator bernie sanders making this point. let me quote from a june 2 article from the "wall street journal," and i quote -- "wall street is tapping a real gusher in 2011, as heightened volatility and higher prices of oil and other raw materials boost banks' profits by 55% in the first quarter." end of quote. banks' profits are soaring as a result of oil speculation. that is the fact. not just "the wall street journal." the c.e.o. of exxonmobil, rex tillerson in response to a question at a recent senate hearing estimated that speculation was driving up the

price of a barrel of oil by as much as 40%. that's the c.e.o. of exxonmobil. you might know something about that issue. the general counsel of delta airlines, a major consumer of fuel, ben hearst and the experts at goldman sachs have all said that excessive speculation is causing oil prices to spike by 20% to 40%. even saudi arabia, the largest exporter of oil in the world, told the bush administration back in 2008 when the bush administration went to them and said we need to drive prices down, produce more oil, sell more oil, they said that is not the problem. saudi arabia said we have got all the oil that we need. the problem is speculation, and they estimated that speculation was -- could result in about $40 a barrel. in other words, mr. president,

the same wall street speculators who caused the worst financial crisis since the 1930's through their greed, recklessness and illegal behavior are back at it again, and this time they are ripping off the american people by gambling that the price of oil and gas will continue to go up and up and up, and in that process are driving the price of gas and oil up and up and up. sadly, -- and this is the important point -- this spike in oil and gasoline prices was entirely avoidable. this was avoidable. the wall street reform act that we passed last year, the dodd-frank legislation, required, under line required, the commodity futures trading commission to impose strict limits on the amount of oil that wall street speculators could trade in the energy futures

market by january 17 of this year. we passed legislation that said to the commodity futures trading commission that you have got to pass -- you have got to impose rules by january 17 with strict limits on excessive oil speculation. mr. president, six months have come and gone. they have not done what they were required to do. almost five months later, the sftc still has not imposed those speculation limits. in other words, the specific regulator on oil speculation is clearly breaking the law and is not doing what he is supposed to be doing. last month, mr. president, i held a meeting in my office with mr. gary gensler who is the chairman of the cftc and six other senators. i have to tell you that i was

extremely disappointed in both the tone of that meeting and the complete lack of urgency at the cftc with respect to cracking down on oil speculators, as required by the law. therefore, today i have introduced legislation along with senators blumenthal, merkley, franken, whitehouse and bill nelson to end excessive speculation once and for all -- once and for all. the american people cannot continue to be ripped off by wall street, who are artificially driving up the price of oil and gas. i am very pleased to also announce that congressman maurice hinchey will be introducing this piece of legislation in the house. this legislation mandates that the chairman of the cftc take immediate actions to eliminate

excessive oil speculation within two weeks -- two weeks. one, our bill requires the chairman to establish speculative oil position limits equal to the position accountability levels that have been in place at the new york mercantile exchange since 2001 -- 2002. 2001. this bill requires the chairman -- so that wall street investment banks back their bets with real capital. three, under this bill, goldman sachs, morgan stanley and other investment banks engage in proprietary oil trading would be classified as "speculators" instead of bonafide hedgers. and, 401(k)'s the chairman of the cftc would be required, under this bill, to take any other action necessary to eliminate excessive speculation and ensure that the price of oil accurately reflects the fundamentals of supply and demand. mr. president, i am pleased to

announce that this legislation already has the support of a very diverse group of organizations representing small businesses, fuel dealers, consumers, workers, airlines, and farmers. and some of those organizations are americans for financial reform, the consumer federation of america, delta airlines, the gasoline and automotive service dealers of america, the international brotherhood of teamsters, the main street alliance, the national farmers union, the new england fuel institute, public citizen, and the vermont fuel dealers association. this is just a few. and i want to thank all of those organizations for their support. mr. president, the american people are sick and tired of being ripped off at the gas pump. people in the northern part of the state, whether it is vermont or minnesota, worry about what the price of home heating oil will be next winter. what we're seeing now in terms

of excessively high oil and gas prices has nothing to do with supply and demand and everything to do with wall street speculation. this congress has told the cftc to act. they have failed to act. now is the time for us to tell them exactly what must happen. thank you very much, mr. president. and, with that, i yield the floor. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: ing officer: the

senator from iowa. mr. harkin: i ask further proceedings under the quorum call be dispensed with. the presiding officer: without objection. mr. harkin: when jerry coonahan leaves the senate employment in the next couple of days we will lose one of the most respected members of our senate family. during nearly two decades of service with the senate, he epitomizes dedication, loyalty and incredible work ethic of the best staff members here on capitol hill. we're saying farewell not just

to a wonderful senate employ, but also to a very good friend. mr. president, jerry coonahan first came to capitol hill as a member of senator john mccain's staff. he later left the senate for a brief time, but returned in 1997 as a tour guide in the capitol building where he truly excelled. in fact, jerry made a bit of history himself. he gave the first public tour following the fatal shaofgt two -- shooting of two capitol police officers in 1998. when the capitol reopened following the attacks of september 11, 2001, jerry again led the first tour of the capitol. four years ago, sadly, jerry was the victim of a violent crime and sustained very grave injuries. he spent over four weeks at the national rehabilitation hospital. it was a long and courageous struggle to learn to walk and speak again, but jerry

persevered and succeeded. unfortunately, jerry was not able to return to his job as a tour guide because of his injuries. but he was hired to work as one of our elevator operators. that's where i and so many other senators have had the pleasure of meeting him and enjoying his company in recent years. i can't tell you how many times during late-night sessions he's brightened our lives with a kind word or bright smile. i can't tell you how many times he's jeopardied us into the -- shepherded us into the sanctuary of his elevator while fending off lobbyists. no doubt about it, gerry counihan has been one of those special people who make the senate a great place to work. now, mr. president, gerry is moving on to a new career with new responsibilities and new

opportunities at the department of health and human services in rockville, maryland. with his departure we're saying goodbye to a standout senate staffer and great friend. we will miss him very much. there are not many things that republicans and democrats agree on in this body these days, but our love for gerry counihan is bipartisan, and indeed i can say this without any fear of contradiction, unanimous. the senate family joins together in wishing gerry happiness and success in his new career. mr. president, with that i yield the floor and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: