Pete Domenici

Mr. DOMENICI

Mr. DOMENICI. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. DOMENICI. Mr. President, I yield 3 minutes to the distinguished Senator from Pennsylvania and the remainder of my time to Senator Nickles following that.

Mr. DOMENICI. I yield the floor.

Mr. DOMENICI. Senator Don Nickles is on the way. I want to discuss the issue a little bit with the Senate. Mr. President, my good friend, the distinguished Senator from Massachusetts, said that he doesn't know how anyone could disagree with these findings--the findings of a national commission appointed by the President. Well, just so everyone understands, the very commission made the findings, and then the commission itself split on whether they should be put in law or not. So I say, with reference to a sense of the Senate and whether we ought to adopt them in law, at least we ought to start with the premise that half of a commission was concerned about the broad picture of health care costs in America and other things and suggested that perhaps it would be better not to put them in law but to handle them some other way. Let me talk a little bit about the upside of what is going on in America with reference to health care costs during this very short era when we have moved away from fee for service toward managed care and HMOs. In doing that, let me hearken back to the joy that permeates this body and the American people when they hear that we have the budget under control. We are in an era of balance. Mr. President, it is almost unequivocal that had we not gone to managed care and HMOs, we would not be celebrating a balanced budget today. That is because under the other system--and I note that the doctors support regulating HMOs more--but under the doctor system, up, up and away went the costs. We had 3 or 4 years when the Federal Government's accounts that paid for health care were going up, compounded in double digits every year, which meant that in short order you would not be able to pay for Medicare, you would not be able to afford Medicaid because, even if we had the ability to borrow and borrow and incur debt, the States would not have been able to pay for it. So let's make sure that everybody understands this short era of moving to managed care and HMOs has brought within the reach of many, many Americans and many American businesses health care coverage they could not have afforded under the old system. As a matter of fact, it was interesting. As I listened to my friend from Massachusetts, I thought about a couple of speeches I gave when we were talking about our not being competitive with Japan on automobiles. I was able to say to audiences that one of the reasons we are not competitive is because the automobile is carrying around in the trunk four times the health care costs the Japanese car is, because our health costs were so enormous as compared with theirs. I am not suggesting theirs is as good as ours, but neither am I suggesting that ours is four times better than theirs. So I think when we talk about tying HMOs and managed care into some kind of rigidity in an effort to solve some problems that may be solved otherwise, we better be careful as to how much we do and how much we mandate versus how much we handle in other ways in an effort to get quality. I also indicate, just by way of an observation, that it is a lot easier to find the shortcomings of HMOs and managed care than it was the old system, because this one is all focused in on management running a system. Before, it was hundreds and hundreds of doctors. To be able to focus on the lack of quality care is much easier. That works both ways. It is good because it calls it to our attention. But it ought to be easier to get quality care than it was before without having to write it into rigid law. I note the presence of my friend, the Senator from Oklahoma. I want to close by just saying that before we make it so impossible for managed care and health care to control costs within reason and deliver health care, everybody should understand that whatever we do we ought to get quality at the best price. We ought not get quality at the expense of those who are paying for it, and at the expense of the U.S. Government. That is what I think ultimately we should do when we get down to trying to legislate. This isn't legislating. It is just us giving our opinion and our ideas as a Senate. When it comes right down to it, that is what we are going to be talking about sincerely in our committees and on the floor. Mr. President, how much time do I have?

Mr. DOMENICI. There is a total of 15 on each side?

Mr. DOMENICI. Mr. President, how much time remains on the proponents' side?

Mr. DOMENICI. I reserve the remainder of my time, and I ask unanimous consent the 3 minutes remaining in opposition and 5 minutes remaining by the proponent be retained subsequent to the debate on the Kennedy amendment, which will start now.

Mr. DOMENICI. I will try to work it in.

Mr. DOMENICI. You have 5 minutes remaining?

Mr. DOMENICI. Mr. President, this is a budget year when the total amount of money available for discretionary spending out of which the NIH is funded was agreed to last year in the bipartisan budget agreement. It is a total dollar number for all of the Government that is not entitlement programs. So it is for education, it is to run the agencies of our Federal Government, it is for the money the IRS needs to pay its workers, and on and on. While it is very close to a freeze this year, there is an additional budget authority of $1.9 billion year over year and an additional $6.1 billion in outlays, about one-half percent. For those who say this portion of Government is growing dramatically, for the next 4 years, because of the agreement, it will be growing at about this amount or less, literally close to a freeze for a sum total of 4 additional years. Very tough. Nonetheless--nonetheless--the President of the United States, in the President's budget, provided some restraint by way of reductions in expenditures. I will just go through to give you examples. The President's budget, in function 150, international affairs, reduced that total function by $530 million; function 300, that is the environment, a $260 million reduction; function 350, agriculture, $240 million; function 370, housing and commerce, that is $640 million; function 400, a $1.25 billion reduction. They go on all the way through. And the sum total in cuts is $7.83 billion. That means the President provided room for programs that he wanted and reduced these. What we have done in our budget resolution is we have taken these reductions but we have given different priorities to how we would spend the money. I want to say to my good friend, Senator Specter, there is no one here who, when it comes right down to being in the trenches where you provide money for NIH, there is nobody who has been more of a leader than he. And, frankly, his subcommittee, which covers a myriad of programs--education, NIH, and on and on--is a subcommittee that is constantly under pressure. I am not going to suggest, as some, that it always needs more and more money. Rather, I will say it is under difficult pressure because of the kinds of programs they have to fund. Having said that, in the budget resolution, where we have some responsibility to establish priorities, somebody else follows us and perhaps can change some, but we know that their subcommittee has most of the priorities that we are for and that he would like to fund. There is no other function with more priorities, other than perhaps the function of defense, which stands there singularly all the time. What we did, we funded that program, because of its being a priority, by increasing significantly the NIH assumption for expenditures. We also increased in that function education because we knew that from the Republican standpoint we wanted to fund the disability program in education, and we wanted to fund some flexibility programs for the States so they could do some things on their own, being relieved of some mandates that we had given them. In that alignment and that set of determining where we spend money and with that backdrop, we have provided in this budget resolution a larger increase in NIH, in the assumption for NIH--the assumption; the budget resolution isn't binding--we have provided the largest increase of any domestic program that is appropriated. That amount is $1.5 billion in the first year. That is an 11 percent increase. Then, in estimating our assumptions for the remaining 4 years, we increase that a total of $15.5 billion for the premier institution researching health in the world--the American National Institutes of Health. We do not determine in the budget resolution which of the numerous NIH activities get what amount of money. I have been to the subcommittee with the distinguished chairman presiding, making a very strong, strong pitch that we put more money in researching mental illness. He recalls that. We were able over the years to raise those kinds of institutes to a level of funding where I can give you two or three which are now on the cutting edge again and which have excited young scientists and the very best to get into fields they might not have that are critical to our solving some of the enormous problems of the suffering of human beings, not only Americans but humans. So I am an advocate. But I guess I would say, in a tight budget, ``Enough is enough.'' And $1.5 billion is enough; $15.5 billion over 5 years is enough. And I cannot do any better. I cannot make the funding any more sure in a budget resolution than I have done in this budget resolution. If Senator Specter is to prevail, we cannot assure anyone that the desired level of NIH funding will be what Senator Specter assumes by his amendment, because he is once again going to be back into the competition of taking all the money that his committee gets, and deciding among hundreds of programs how much the NIH gets. So that is one side of this coin. Now, with every coin, there are two sides. When you add, you have to take away. Because the distinguished Senator did not try to break the budget. He did not try to break the caps, because he pledged last year--and he kept his pledge--that we would stay on this path of a balanced budget and the caps. There are some who would like to break the caps for any good proposal. The distinguished Senator from Pennsylvania is not doing that. He is saying, let us cut other domestic programs to pay for the new increase over and above the $1.5 billion that we provided. And the Senator included defense in the .4 percent cut. So defense gets cut across the board, and domestic programs get cut across the board. So defense gets cut $1.1 billion over 1 year in order to pay for this $2 billion increase. I will just tick off some so everybody knows. The veterans get a $76 million reduction; the environment gets an $89 million reduction; agriculture, because it is smaller, gets a $17 million reduction; transportation, $160 million; and on and on. It may very well be that the U.S. Senate today wants to say, in addition to what the budget resolution contains, with all the other programs being restrained dramatically, that in order to give it $2 billion more, we ought to do these things, including cutting defense $1.1 billion. I do not believe the Senate will do that. But if they choose to do that, then obviously the appropriators will have to give that every consideration. I do not see how we can do the defense one, because we are already having a very difficult time meeting the defense needs with the numbers that are in the budget and the firewall that protects. Let me just share a thought with the distinguished Senator. I say to Senator Specter, you said you want to do this to defense also. I would like you to think about that, because if you do, then I believe the firewall prevails and you may have a supermajority requirement. But I leave that to you; that is not for me. Having said what I have said, I do not want to detract from the fact that the National Institutes of Health are a fabulous community of the best scientists in the world. When you really look at what they are doing, they are on a course to cure many, many aspects of human suffering and human disease. When you add to what they are doing in the normal research, you add something like the genome mapping, the mapping of all the chromosomes of the human body, and those are being looked at in terms of their relationship to disease. You have a formidable group of scientists and research equipment moving in a path of, perhaps, what may be called the generation yet to come, which will be a wellness generation. That could be, when the dread diseases are no more. So I don't want to sound like this is just a typical entity. It is a very prominent and important one. I do believe, consistent with limited resources and because we have to tax our people, we have limited resources. Some think they are taxed too much already. I believe the budget resolution treats this formidable research community fairly well. I reserve the remainder of my time.

Mr. DOMENICI. I did say that.

Mr. DOMENICI. I have no objection to the modification.

Mr. DOMENICI. Sure, when I said the opposition will have 15 minutes, we will have 14 and we will give 1 of them to the Senator from California.

Mr. DOMENICI. Of course.

Mr. DOMENICI. Mr. President, I ask it be in order for Senator Specter to proceed with an amendment that he has, and that time in opposition to the Boxer amendment, which is 15 minutes, be retained to be used by the opponents subsequent to the debate as agreed to heretofore on the Specter amendment.

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

Mr. DOMENICI. I suggest the absence of a quorum.

Mr. DOMENICI. Mr. President, I understand that we have, between the minority and the majority, a list of six amendments that we would like to present. Senator Brownback is No. 1 on that list; followed by Senator Boxer; followed by Senator Specter; followed by Senator Lautenberg; and then we would have another one in there, and we do not know whether it would be Senator Connie Mack or otherwise; and Senator Kennedy. I want everyone to know that we are trying very hard to get to a point where there is not very many amendments left for full debate. It does not mean we have yet arrived at how many would be entitled to a vote under the ``vote-arama'' with 1 minute. We are working on that right now. We need a lot of cooperation. But I think it is fair to proceed, I say to the leader, with this amendment. This is not one of the three or four we would choose to resolve these issues, but we had already made that commitment. And we will work on it as best we can. I yield the floor. Mr. BROWNBACK addressed the Chair.

Mr. DOMENICI. I suggest the absence of a quorum.

Mr. DOMENICI. Mr. President, I thank Senator Thurmond for his kind remarks. Obviously, he has, for a number of weeks now, been very concerned about the situation with reference to the Defense Department and the many things we must do in order to be militarily prepared to take care of our men and women in the military. I believe the issues that confront us have more to do with how you make estimates of what the program is going to cost than anything else. We are trying to work something out where those will be more realistically evaluated than perhaps have been in the past. I thank the Senator for his compliments and pledge I will do everything I can to get this done right.

Mr. DOMENICI. Mr. President, I yield to the distinguished chairman of the Armed Services Committee as much time as he desires off the bill.

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

Mr. DOMENICI. Mr. President, I suggest the absence of a quorum for 1 minute.

Mr. DOMENICI. This is another reserve fund. The reserve fund has the advantage, for the proponent, of creating a new series of entitlement programs, thereby indirectly breaking the caps. If you would try to spend these in the normal way, we would be breaking the budget. So it creates a series of potentially new entitlement programs. If we ever get taxes increased or other programs cut, the resources can be put into this reserve fund. I don't believe we ought to be doing this. I have objected to them regularly here on the floor when there is no real source of money. I think we should sustain the budget point of order on this one and not start another approach to a new series of entitlement programs.

Mr. DOMENICI. What is the next amendment? Amendment No. 2195