and the other is going to be alzheimer's. we know that. this bill is about health care costs in the future. and if you -- you know, all the other diseases can make a unique case. yes, they drive -- a lot of them can. but nothing -- but they all pale compared to obesity and alzheimer's. cancer is such a diffuse disease. it's not a -- it's not a single homogenous disease event. so i just think in this area, long-term potential for cost is so dramatic that a statement that we're willing to try to push on a policy which will reduce the institutionalization is important. rchlt >> i'm not going to debate you on your point you make. i think it's a legitimate one. in the sense of the senate, has some appeal. i have a feeling somebody else is going to approach me in five minutes and ask for something else to be included as well. because it doesn't require anything but highlighting it. i just -- i say respectfully, i kind of -- i'll do whatever you want to do, but it's one of those matters. >> if the chairman doesn't want to entertain this, i can ap

so it's not disease-specific but certainly in the case of alzheimer's, the extent someone can get some he,@@@@@ @ @ work. but pizzi is at home and he wants to keep her there and she wants to be there. getting that kind of help, to have someone to be supportive of someone with als or alzheimer's i think is of great value and i hope at some point we would look at providing support for those goifing support. >> i did not know 60% higher rate among veterans. >> the als groups that we have been meeting with, there is a study, there's a registry within department of defense, to try to understand what it is that we're seeing. the registry is relatively new. >> if i could say, the incidence of ms, multiple cler oes is, als and a number of issues from gulf war veterans from the early '90s is what senator murkowski is referring to. >> is there any epidemiology cal research anybody has done on it? >> we've been working on it. >> there is research that's going on, but it's limited research. this is -- it's been described as an orphan disease. there's only, like, 30,000 people. only. that's a lot o

he did not have much say because he had alzheimer's. one thing i like to see that nobody is suggesting in washington, if we are going to have a public health insurance option, there have to be some things that the american people are responsible for, not the government or the private sector. one of them is having a living will and power of attorney. either everyone should be required to have a living will and power of attorney. that means they will give directions to whoever is in charge if you cannot be about the general guidelines of your care. if your dad had been able to say 10 years ago before he develop alzheimer's, -- if i have the disease from which there is no hope of reasonable recovery, no extraordinary means to be taken, and these are the things that should not be done. they would not have taken him to the hospital. if they did, they would have faced a lawsuit. that is the kind of stuff that individuals ought to have some recourse. we do not want rationing, unless we are doing it to ourselves. i have a living will. most peop

of those diseases, this disease is a loan if they are just aggressively, i believe for example that alzheimer's is going to be probably the biggest cost driver of healthcare because of the size of the retiring generation, which will double from 35 million to 70 million the fact we know the people over 85, their chances of having alzheimer's is extraordinarily high. i think it is over six year 70%. if we can figure out a way to incentivize caretakers to not institutionalize those folks, that is important in obviously research and then of course we know obesity is a huge cost driver for society and we know that prescreening in the area of certain cancers, it to get them early you save lives. we know for example like expectancy of someone gets breast cancer in england is 70%. like expectancy in the united states is 92% because we prescreen so soon and that is something we need to incentivize for their threw cash rewards. so, there are a lot of issues out there and i just think this title should not be controversial title. i do believe we should be able to work out things that used the force of inc

the studies of alzheimer's, "losing a million minds," became the bible for alzheimer's policies in america. the o.t.a. study on social security computer systems resulted in changes saving hundreds of millions of dollars. hundreds of millions of dollar. the study on sin fuels resulted in policy savings. the o.t.a. study on the use of genetic testing in the workplace as a tool of discrimination and bias laid the groundwork for the excellent legislation that representative slaughter, the chair of the rules committee, developed in the genetic nondiscrimination act. an o.t.a. report on electronic delivery of federal services led to the food stamp fraud reduction act. and on and on. but in a fit of budget cutting, o.t.a.'s work stopped 14 years ago. with the explanation that the work could be obtained elsewhere. from other government agencies, from other congressional agencies, from interest groups, from universities, from our friends back home, from some other sources. well, we've done the experiment. it didn't work. we have not gotten what o.t.a. provided in the 14 years since o.t.a. stopped o

hd medications given to elderly people to push off the early effects of alzheimer's disease. >> cognitive enhancing medications, that is something we will be hearing a lot about, about the morality, legality and so forth. >> not to be labor the point but let's say you came up with a good cognitive enhancement drugs that have a low side effect profile, give it to everybody. i am just making that up. >> there is no reason that it is unethical to do better. all of these substancess are dangerous if misused. that is where the problem comes. just a quick fact. if you give stimulant drug is to a child with a ph.d. it works. if they don't become addicted to it, it actually reduces their probability of later developing an addiction. it is a balance the screen taking it because you need it or because you think it will make you perform better. these are complex issues which is why we have doctors. >> you said we are not where we should be. where do you see us going? what the you think the next 15 years are going to look like? >> i believe science is hope. if you look at the basis of the track recor

consent that my full statement and letters of support from the following organizations -- the aarp, the alzheimer's organizations, the duke university divinity school, institute on care at the end of life, the national hospice and palliative care organization, united health care, aetna and others -- appear in the record immediately following my statement. the presiding officer: without objection, so ordered. mr. warner: thank you, mr. president. and i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: quorum call: mr. mcconnell: mr. president? the presiding officer: the republican leader.

costs for the vulnerable medicare beneficiaries, those with multiple severe chronic conditions, such as alzheimer's, als, parkinson's and other complex debilitating diseases who also need help with two or more activities of daily living, such as dressing, feeding, et cetera. cbo has reported that 5% of medicare beneficiaries account for 43% of overall medicare spending, and cms has noted that approximately 20% of medicare beneficiaries are with five or more chronic conditions account for 66% of program spending. could you talk a little bit about how we can focus on those medicare beneficiaries with multiple chronic diseases, and how perhaps a program like that focusing on home and better coordination can help reduce the costs? >> well, we have not only the demonstration that you are responsible for, but i think a number of projects under way looking at coordinating care, particularly for the vulnerable high-cost individuals, and certainly having an opportunity to do that in a home base, instead of a hospital based service is not only better for the patient, but may provide some enhanced cost saving

if we could delay the onset of alzheimer's by just 3 years, we would save billions of dollars. half of the nursing-home the country, talk about depression, schizophrenia, any of these things. we need a cap tax budget in the united states. we need to put the money in translation research to find better remedies. we are on the threshold of personalized madison, we know that if we can no your gene map we can probably taylor something that would treat your depression. and on and on. there was a study recently on prostate, they said there are probably 50 kinds of prostate cancer but we don't know how to diagnose that so we treat everybody the same. the same with lipitor. lipitor may not work for me. we can see the future but we can't quite get there. the only way is a capital budget at the federal level, where we borrow the money, make the investments and move the needle. it will save us billions of dollars. [applause] >> congressman gephardt has outlined the objectives of individualized medicine including mental health. let me pose a question this way. what is the rate limiting sai

>> okay, because i have alzheimer's i will ask your part of the question. [laughter] basically the first part is what is the reaction to conservatives. okay, i worked at cbs news ultimately for 20 years before i put to write "bias", and at the 25 year mark, not a lot of people were for one company for 25 years, i wrote an op-ed in "the wall street journal" about liberal bias. i don't think any other mainstream journalists had ever written about liberal bias early while he was still working for a big mainstream music. it touched off the media equivalent of world war iii. they don't take it well. i told dan rather the day before the article came out, he was and i was covering the caucuses in february 1996, and i said, i wrote something that is going to be in "the wall street journal" tomorrow and any to give you a heads up and i don't thank you are going to like it. he said to me, this was 1996, how many years ago, 15 years ago -- 13 years ago. he said, bernie, he did not know what it was about, he said we were friends yesterday, we will then stay -- what did

if i was drawing on personal examples i would talk about alzheimer's and ms in my family. if i was looking at my district i would talk about diabetes and the native american population. once we go down the slope we would have a lot of arguments here that would be well intentioned but probably not productive for us and i don't think i have opened the door for two and not open it up for all. let me ask you specifically. i think, but i want to make sure, is the president's position on healthcare now that it would be mandatory everybody participate, somewhat of a shift from the campaign, so has the made that decision yet? >> he has not congressman. key, as you know in the campaign he supported a mandate with regard to parents with children. he did not support any individual mandate. i think what he has it pretty consistently though is that he is open to engaging in that conversation with congress. he knows that a number of members of congress are very committed to an individual mandate, as have been some of the stake holders at the table, so i think at this point he has not ma

it is prevented patients in the early stages of alzheimer's to get the medication which lets them get worse than penekamp the help. it is denied life prolonging treatments to kidney cancer patients and allowed a small percentage of patients with osteoporosis to receive the medicine and then only as a last resort, it is also been denied, used to deny drugs available to treat aggressive brain tumors. i just don't want that to happen in the united states, so i would hope we would not allow the quality adjusted life year process measure to be used. >> mike. >> that is that. a very small part of an important. >> first of all, what the senator from wyoming's the amendment would do is prevent the agency on health research quality from developing measures or methodologies for the denial of medicare benefits to patients on the basis of age or expected life. i think that the amendment is unnecessary. section 219 in the bill would generate more-- when actually generate more personalized, more reliable research that is more relevant to individual patients and doctors than any other research progr

breakthrough drugs and they force patients to wait extra years before they can get treatments and they kept alzheimer's patients from receiving early treatment and they've had life for longing kidney cancer patients and all of these things. that's quality-adjusted life year, qlay. i'm interested in making those kind of decisions in america. my amendment number 8 is prohibiting the use of denying medicare patients to the elderly and the vulnerable patients against their wishes. that would just be a little piece again. it wouldn't be a mandate or a broad thing of prohibiting everybody, but it might be able to be used and it's the misuse that we're worried about and we don't bend the cost -- i guess we would bend the cost by denying those thing, but i don't think that's any of ouren tent to do that. so i think we're trying to do that in too few words and prohibit is too broad because as you mentioned, maybe it keeps the dissemination of the information from happening which is why senator coburn suggested that extra sentence. i do think we need to take some care with this and that's the reason that there's

situation, where the blocks breast cancer patients from receiving breakthrough drugs, and they kept alzheimer's patients from receiving the early treatment. they deny the life prolonging kidney cancer patients and all of these things. that is quality adjusted life, qa l why. i'm worried about them using this information to make those kinds of decisions in america. my amendment number as is prohibiting the use for the nine medicare benefits to the elderly and the vulnerable patients against their wishes. co which is be a little piece again so would not be a mandate. the would might be able to be used and it is the issues we are worried about. we don't bend-- i guess we would bend the cost curve by denying those things but i don't think it is it any of our intent to do that. so i think maybe we are trying to do this into a few words. and prohibited is too broad, because as you mentioned, it keeps, made it keeps the dissemination of the information from happening which is why senator coburn suggested that extra sentence. i do think we need to take some care with this and that is the reason there's