Daniel Moynihan

Mr. MOYNIHAN

Mr. MOYNIHAN. Mr. President, I commend the distinguished Democratic Leader Senator Daschle on his statement and join him in supporting the Democratic BBA Refinement and Access to Care Proposal. As the Leader said, the Balanced Budget Act of 1997 (BBA) has cut Medicare spending far more than had been intended. Our Democratic proposal would spend $80 billion over 10 years to mitigate the unintended effects of the BBA on our nation's health care providers and beneficiaries. In particular, I want to highlight that our package would prevent further reductions in payments to our Nation's teaching hospitals. The BBA, unwisely in my view, enacted a multi-year schedule of cuts in payments by Medicare to academic medical centers. These cuts would seriously impair the cutting edge research conducted by teaching hospitals, as well as impair their ability to train doctors and to serve so many of our nation's indigent. Last year, in the Balanced Budget Refinement Act (BBRA), we mitigated the scheduled reductions in fiscal years 2000 and 2001. The package we are proposing today, would cancel any further reductions in what we call ``Indirect Medical Education payments,'' thereby restoring nearly $7 billion to our Nation's teaching hospitals. I have stood before my colleagues on countless number of times to bring attention to the financial plight of medical schools and teaching hospitals. Yet, I regret that the fate of the 144 accredited medical schools and 1416 graduate medical education teaching institutions still remains uncertain. The proposals in our Democratic BBA refinement package will provide critically needed financing in the short-run. In the long-run, we need to restructure the financing of graduate medical education along the lines I have proposed in the Graduate Medical Education Trust Fund Act that I have introduced in the last 3 Congresses. That legislation would require the public and private sectors to provide support for graduate medical education. More on that later. My particular interest in this topic goes back to 1994 when the Finance Committee took up the President's Health Security Act. As Chairman of the Committee I asked Paul Marks, then President of Memorial Sloan-Kettering, Cancer Center to arrange a ``seminar'' for me on health care issues. We convened on Wednesday, January 19, 1994 in the Laurance S. Rockefeller Boardroom at 10 a.m. At about a quarter past the hour I was told that the University of Minnesota might have to close its medical school. Whereupon my education in this began. Minnesota is where the Scandinavians (Swedes) settled. They don't close medical schools; they open medical schools. What was going on? It was simple enough: managed care had reached the high plains. The good folk of Lake Wobegon had dutifully signed on, only to learn that market-based health plans do not send patients to teaching hospitals, because they cost too much. No teaching hospital; ergo no medical school. In the Clinton Administration health security plan, they assumed health care costs would continue to rise. The Administration's solution to this was rationing--cut the number of doctors by one quarter, specialists by one-half and so on. As I have described elsewhere, a dissenting paper dated April 26, 1993, by ``Workgroup 12'' of ``Tollgate 5,'' was written by a physician in the Veterans' Administration. Workgroup 12 was part of the 500 person Clinton health care task force. The paper began:

Mr. MOYNIHAN

Mr. MOYNIHAN. Mr. President, I rise to congratulate the chairman of the Finance Committee. This measure has now had its first test. It has passed overwhelmingly, 86-12. We have trouble getting such votes on the Fourth of July celebrations. Here is some sense of how epic this vote will be. At the Finance Committee's final hearing on China, on April 6, the former Chief Negotiator for Japan and Canada at the Office of the U.S. Trade Representative closed his testimony thus: ``this vote is one of an historic handful of Congressional votes since the end of World War II. Nothing that Members of Congress do this year or any other year could be more important.'' We are asking, pleading to leave this bill untouched. We want it to go out of this Chamber directly to the President at the White House where it will be signed. We do not want a conference. We do not want another vote on the House floor. The majority leader promised that the Senate would begin its consideration of H.R. 4444, the legislation authorizing the extension of permanent normal trade relations, PNTR, to China before the August recess. He has kept his word. We owe great thanks as well to our esteemed minority leader, Senator Daschle, who has been tireless on this matter, and to our great Chairman, Senator Roth, whose efforts have brought us to this day. Today's vote puts us on course to take up and pass this important legislation early in September. I have no doubt that the measure will prevail--and by a wide margin. It comes to us following the decisive vote in the House of Representatives on May 24--over two months ago now--237 ayes, 197 noes. And it comes to the floor with the unequivocal endorsement of the Finance Committee: on May 17, the Finance Committee reported out a simple, 2-page bill--a straight-out authorization of PNTR. The vote was nearly unanimous, 19-1. The House saw fit to add a few more provisions, which the Finance Committee studied in Executive Session on Wednesday, June 7. Our conclusion was that there is nothing objectionable in it. The House added the package offered by Representatives Levin and Bereuter. It includes an import surge mechanism to implement one of the provisions of the November 1999 U.S.-China agreement, fully consistent with existing law. It creates a human rights commission loosely modeled after the Commission on Security and Cooperation in Europe, the Helsinki Commission. And it authorizes appropriations to address China's compliance with its WTO commitments. Nothing major. Nothing troubling. It was the nearly unanimous view of the Finance Committee that we ought simply to take up the House bill and pass it. And the sooner the better. I will make two observations. First, with its accession to the WTO, China merely resumes the role that it played more than half a century ago. China was one of the 44 participants in the Bretton Woods Conference, July 1-22, 1944, and its representatives were seated on the executive boards of the World Bank and the International Monetary Fund when those two organizations came into being in 1946. That same year, China was appointed to the Preparatory Committee of the United Nations Conference on Trade and Employment, which was charged with drafting both the Charter for the International Trade Organization (ITO) and the General Agreement on Tariffs and Trade. China was one of the original 23 Contracting Parties of the GATT, which entered into force for China on May 22, 1948. Following the establishment of the People's Republic of China, the Republic of China (Taiwan) notified the GATT on March 8, 1950 that it was terminating ``China's'' membership. Thirty-six years later, in 1986, China officially sought to rejoin the GATT, now the WTO. After 14 years of negotiations, it is now time. My second broad observation is that the economic case for PNTR is unassailable. Ambassador Barshefsky negotiated an outstanding market access agreement: that much is not in dispute. It is a one-sided agreement: it was China, and not the United States, that had to make significant and wide-ranging market access commitments. Once China becomes a member of the World Trade Organization--and China will become a WTO member with or without the support of the United States Congress--the concessions that China has agreed to in negotiations with the United States and other countries will be extended to all countries that enter into full WTO relations with China. This is simply a consequence of the operation of the ``normal trade relations'' principle--the old ``most-favored-nation'' principle, to use the 17th century term. But until the United States grants China permanent normal trade relations, we will not be guaranteed the benefits that our own negotiators secured. This is because the process of annual renewal and review of China's trade status, conditioned as it is on freedom-of- emigration goals, violates the core principles of the WTO's General Agreement on Tariffs and Trade 1994, the General Agreement on Trade in Services and the Agreement on Trade-Related Aspects of Intellectual Property Rights--all of which require unconditional normal trade relations. A vote in support of PNTR for China is not an endorsement of China's record on human rights. To be sure, there is much to be done. But the annual NTR review process has simply not provided us much leverage on human rights because the sanction is too extreme--the reimposition of the Smoot-Hawley tariff rates, that would choke off our trade with China-- and has never been imposed. The United States has extended our ``normal''--i.e. ``normal trade relations'' or NTR--tariff rates to China each year for the past 20 years. Since 1980. Without a break. This legislation simply recognizes that this long-standing policy will continue. We will have a good debate when we return in September. And then I predict that the Senate will pass H.R. 4444 by an overwhelming margin, as we ought to do. I again thank our dear friend from North Carolina.

Mr. MOYNIHAN

Mr. MOYNIHAN. Mr. President, I yield 5 minutes to the distinguished Senator from Montana.

Mr. MOYNIHAN. Mr. President, once again, I express my gratitude for the graciousness of our chairman and his generosity in these matters, I thank him for his diligence and his scrupulousness and his integrity, as always. I yield the floor.

Mr. MOYNIHAN. Mr. President, I move to reconsider the vote.

Mr. MOYNIHAN. Mr. President, might I first express my gratitude to our chairman who suggested that the 10 hours reserved for a conference committee report be reduced, in this case, to a half an hour in order that we might continue with the Senate's business on appropriations, the sooner to reach the issue of permanent normal trade relations with China, which is a wholly admirable purpose with which I agree and congratulate him. Having said that, I cannot wholly recognize the legislation he describes. I cannot be entirely certain because, although I was a conferee, as appointed by the Senate, to the House-Senate conference on the bill, I was never notified of any meeting, and all I really know about this legislation is what I read in the newspapers. I read this morning in the New York Times on the front page an article by Richard W. Stevenson, a well-respected journalist, with the headline: ``An Effort to Soften a Tax Cut Only Hardens the Opposition'': Hoping to make it harder for President Clinton to veto a measure they see as having tremendous political appeal, Republicans have unveiled a new version of their tax cut for married couples, but as the bill passed the House today, they promptly found themselves under fire for making the bill cost $44 billion more overnight. Mr. President, $44 billion more overnight. The ways in which this happened are obscure, but the outcome is clear. The House originally passed a $248 billion measure. This now is $292 billion, almost a third of a trillion dollars. In the Finance Committee and on the floor, the Democratic Members made the point that, yes, the marriage penalty needed to be addressed, and we had a measure, a device that was simplicity itself. We said in one sentence: A couple is free to file jointly or singly, period. There are 65 marriage penalties in the Tax Code. The measure before us deals with one, half of another, and half of yet another, leaving, if you count, as you will, 62 or 63 untouched. The most notorious and the most difficult, dealing directly with a palpable social problem, which is that of single parents, is the earned-income tax credit. In this morning's New York Times, also, there is an article by David Riemer, who is the Milwaukee director of administration for the Wisconsin's welfare replacement program, which has received very encouraging notices in recent years. It is entitled ``The Marriage Tax on the Poor.'' He describes how this works. The earned-income tax credit evolved in the aftermath of President Nixon's effort to establish a guaranteed national income, family assistance plan, and Congress rejected that. The House passed it. The Senate did not. The Senate thought at least we should do something equivalent for people who work; hence, the earned-income tax credit. It has been expanded over the years, and it is our most effective antipoverty program, period, if you describe poverty in terms of resources, of income. I read one paragraph: The earned-income tax credit's marriage penalty can be huge. Imagine a young woman and the father of her two children, living together as one household, unmarried but hoping to wed. She earns $12,000 a year; he earns $20,000. Under the tax rules, her credit is the maximum, $3,888. If they marry, the mother's ``family earnings'' will rise from $12,000 to $32,000. Her credit will go from $3,888 to zero--a big loss of income for a couple of such modest earnings. The bill before us does almost nothing about that, less than the bill that left the floor in the middle of this week. Our alternative measure is simplicity, one line, which says to that couple, as to any other: By all means, get married and choose to file jointly or separately. Separately, you retain the mother's earned- income tax credit. This is a great opportunity lost, part of a strategy to have lots of individual tax cuts which will cumulate into an enormous tax cut. The President has said he will veto it. He should. We can get back to this next year. Do the simple thing, the reasonable thing: Get rid of all marriage tax penalties, 65 in all, and particularly those on the poor deriving a significant benefit from the earned-income tax credit. Mr. President, I ask unanimous consent that the op-ed, ``The Marriage Tax on the Poor'' by David Riemer, in today's New York Times, be printed in the Record following my remarks.

Mr. MOYNIHAN. Mr. President, I yield the floor. My friend from Massachusetts has 2 minutes.

Mr. MOYNIHAN. Will the Senator yield?

Mr. MOYNIHAN. Has he seen the conference report?

Mr. MOYNIHAN. Did the Senator hear there was a conference?

Mr. MOYNIHAN. Well, I am a conferee, and, while I heard there was a conference, I wasn't told about any meetings.

Mr. MOYNIHAN. This is one such instance.

Mr. MOYNIHAN. Mr. President, I am happy to yield 1 minute from our side.

Mr. MOYNIHAN

Mr. MOYNIHAN. Mr. President, on the first of May of this year our nation lost a great friend. David Mahoney's meteoric rise in the world of advertising and business is well-chronicled. But less known are the extraordinary contributions he made to the advancement of science--in particular, the vast field of research associated with the human brain. After an astonishingly successful career at conglomerates such as Colgate-Palmolive and Norton Simon, David Mahoney spent the last ten years of his life devoted to the work of the Dana Alliance for Brain Initiatives. This group has brought together the world's foremost neuroscientists who work tirelessly to discover the scientific breakthroughs that will one day provide us with the capability to prevent and effectively treat such disorders as schizophrenia, Parkinson's disease, depression and Alzheimer's disease. David Mahoney was an individual of remarkable accomplishment and dedication. Together with his family and enormous circle of friends, we shall miss him greatly. We are consoled in part to know that the work he did lives on. The attached notice of David Mahoney's death appeared in the New York Times on Tuesday, May 2, 2000. Of particular interest is the moving tribute written by Dr. Max Cowan as published in the Dana Alliance newsletter. I ask that both articles be printed in the Congressional Record. The articles follow: [From Dana Alliance Member News, Apr./May 2000] Remembering David (By Max Cowan) I first met David Mahoney at a week-end retreat for selected CEOs that Jim Watson had organized at the Banbury Conference Center at Cold Spring Harbor. Jim, with characteristic imagination, thought it would be interesting to expose business leaders to recent advances in biology and bio-medical research, and on this occasion focused the retreat on neuroscience. I was one of five or six neuroscientists who were invited to participate and as it happened I was asked to give the first talk on the structure of the brain. It occurred to me that most of the participants had probably never seen a real brain, so I brought a formalin-fixed human brain with me and, on the Friday evening, proceeded to demonstrate and dissect it. Unlike most of my students, who seemed rather blase about seeing and even handling the brain, this group of distinguished businessmen was completely fascinated to learn about and, at one point, to actually touch the brain. As one of them later remarked, ``this was one of the most moving experiences I have had.'' I had quite forgotten about this event until one morning, just over ten years ago, I received a phone call from out of the blue by someone who introduced himself with the words: ``Dr. Max, you probably don't remember me. I'm David Mahoney and I want you to know that you changed my life.'' I was so taken aback that the only thing I could say was, `` I trust the change was for the better''! ``Do you recall speaking at a retreat at Cold Spring Harbor almost two years ago''? David asked. ``I was one of the participants and I can still remember vividly your dissecting a brain for us. That weekend had a profound effect on me. I went home afterwards and said to my wife, `Hille, I think I should give up working and spend the rest of my time trying to do something to promote research on the brain and its disorders,' And that's what I've been doing over the past several months, and now I need your help.'' It was not until Jim Watson organized yet another meeting at Cold Spring Harbor, this time to discuss ``Funding the Decade of the Brain'' that I had a chance to speak to David directly. At this meeting, which included several leading basic and clinical neuroscientists and representatives of a number of funding agencies--both federal and private--the topic of concern was: Why had the presidential proclamation that the 90s were to be the ``Decade of the Brain'' not led to additional support for brain science? Like most such meetings, the first session, on Friday afternoon, was fairly unproductive. There was a good deal of breast-beating and anecdotes about worthwhile research projects that had gone unfunded, but no real suggestions as to what might be done. At dinner I found myself seated next to David. With that insight and forthrightness that I came to admire so much, David came straight to the point. ``Max,'' he said, ``these people seem more concerned about the support of their own work than for the suffering of people with neurological and psychiatric illnesses. I want you to begin this evening's session by proposing something concrete, something that can be done over the next nine years. And if you guys who are in the business can come up with something that seems worthwhile, it's possible that the Dana Foundation may be able to help to get it off the ground.'' Out of this conversation and the discussions that followed that evening and the next morning was the Dana Alliance for Brain Initiatives (DABI) born. In fact, before the Saturday morning session ended, an agenda that had been outlined, the scope of the organization sketched out, an executive committee selected, and the timetable for several specific activities set. None of us who were present at the meeting could have guessed that within a year DABI would have established itself as the single most important new effort to promote awareness of the magnitude of the problems presented by such disorders as Alzheimer's disease, stroke, Parkinson's disease, depression, schizophrenia, blindness, serious hearing loss, and chronic pain. But then none of us had seen David in action, nor had we been closely associated with someone whose vision and imagination were so closely matched by his energy and determination. Drawing on his experience of a lifetime in business, his wide range of contacts with leaders in so many fields-- politics, the media, sports, and academia--David seemed tireless in his efforts to get across the message that brain disorders are among the most serious we have to address. In meeting after meeting, in schools, community centers, in TV studios and the halls of Congress, he kept reminding his audience, whether large or small, that sooner or later nearly all of us will be impacted, either directly or indirectly, by some disorder of the brain. How often he stressed the seriousness of these illnesses, not only for the patients themselves, but also for their families and communities; what an enormous burden they imposed in terms of human suffering, of lost employment, of misunderstanding and even shame and embarrassment. And, he repeatedly pointed out, with the aging of our population these disorders will soon strain to the breaking point our health care system and social services. Only David's family and closest associates were conscious of how he criss-crossed the country with this message; and no one was surprised when the opportunity presented itself, that he quickly extended his efforts across the Atlantic to meet the European DABI. But for many of us, David will always be remembered not just for his energy, enthusiasm, and drive, but for his quite extraordinary capacity for friendship and his ability to encourage others to rise above themselves. Some weeks ago I had occasion to speak at a memorial service for a colleague, Dr. Daniel Nathans, and was moved to quote some lines from the dedication of Tennyson's great poem, ``Idylls of the King.'' These same lines have been running through my mind since hearing of David's death, and they bear repeating here: The shadow of his loss drew eclipse, Darkening the world, We have lost him; he is gone. We know him now; all narrow jealousies Are silent, and we see him as he moved, How modest, kindly, all-accomplished, wise, With what sublime repression of himself And in what limits, and how tenderly Not swaying to this faction, or to that; Not making his high place the lawless perch Of wing'd ambitions, nor vantage-ground For pleasure; but through all tract of years Wearing the white flower of a blameless life, Before a thousand peering littlenesses.

Mr. MOYNIHAN

Mr. MOYNIHAN. Mr. President, Howell Raines, Editorial Page Editor of The New York Times has written a warm and wonderful tribute to Paul Coverdell, recalling his career in the Georgia State Senate in the 1970s. It is part of his life story that is not widely known here in Washington--certainly not by me--and helps to account for the great affection and respect in which he was held here in the United States Senate. Withal this adds a touch to our mourning, we are much indeed indebted to Mr. Raines memoir. I ask unanimous consent that the ``Editorial Notebook'' from this morning's New York Times be printed in full in the Record.

Mr. MOYNIHAN

Mr. MOYNIHAN. Mr. President, I very much appreciate the courtesy of my friend from Vermont because I rise to support the views of my friend from Utah, who spoke so carefully about the matter of price controls. Sir, I do not expect to have any considerable influence on what we do today. But I would like, in a very short order, to try to put what we are doing in a perspective. This began, for me, during the period of the Finance Committee hearings on the health care legislation submitted to us by the administration in 1993. At one hearing, a professor, Charles Fahey, of Fordham University, speaking for the Catholic Health Association, said: What we are witnessing in the country is the commodification of medicine. And down the table, the head of the UCLA hospital said: Can I give you an example? In Southern California, we now have a spot market for bone marrow transplants. This thought stayed with me, that market forces were beginning to shape decisions in health matters as they had not done before. It was particularly poignant that the first institutions that would have trouble in this new situation would be the medical schools and the teaching hospitals, which, as economists say, are public goods. Everybody benefits from public goods so no one has an incentive to pay for it--and we are seeing this all over the country in a short 6 years. Now, today, we are seeing another phenomenon of a market that comes into being as railroads did, as oil refineries did, oil producers, as has been going on through the history of free markets and free enterprise, which is price controls. There is something about our political systems in the West that responds to the creation of new markets and the seeming rise in prices in those markets--when, in fact, quality rises--that says perhaps we could control this by controlling the price. It always fails, Mr. President. It is the one thing you can say with a large degree of confidence that in the 20th century this effort always fails. Sometimes it fails by producing black markets where the laws are not obeyed; others by simply depressing the quality of the products in the market. That is what we have to watch for here in the main. We are dealing with thoroughly responsible organizations. The Pfizer Corporation, from my city of New York, began work in Brooklyn in 1849, developed the first treatment for parasitic worms in the mid-19th century when that was a rampant endemic disease. It has since gone on to do other extraordinary things. It was the first major producer of penicillin in the United States, which was a drug of such enormous consequence in the Second World War, the first time we were able to destroy one cell in a body without destroying others. Today Pfizer has 12,000 researchers with a budget of $4.7 billion, larger than the budget of the National Science Foundation. I say, sir, impose price controls, which always seems like a good idea at the time, and in a short order there will be no such budget. A period of enormous innovation, very recent in the history of medicine, will come to a close. I see my time has come to a close. I ask unanimous consent to print in the Record the paper I gave at the 42nd annual Cartwright Lecture as reprinted in ``Academic Medicine,'' the journal of the Association of American Medical Colleges.

Mr. MOYNIHAN

Mr. MOYNIHAN. A voice vote would be very agreeable.

Mr. MOYNIHAN. Mr. President, I move to reconsider the vote.

Mr. MOYNIHAN. Mr. President, I move to reconsider the vote.

Mr. MOYNIHAN. Mr. President, I move to reconsider the vote.

Mr. MOYNIHAN

Mr. MOYNIHAN. Mr. President, I take this occasion to thank the persons who have supported us and, most particularly, to thank the minority staff of the Finance Committee which produced what we think to have been a fine measure. We are, as ever, indebted to our chief of staff, Dr. David Podoff, who, in the course of these deliberations, had Marshall's ``Principles of Economics'' on his desk for reference; to our tax team, led by Russ Sullivan, Stan Fendley, Mitchell Kent, Jerry Pannullo, Cary Pugh, John Sparrow, Lee Holtzman, Matthew Vogele, and Andy Guglielmi; to our health team, Chuck Konigsberg, Kyle Kinner, Kirsten Beronio, and David Nightingale. Also, I extend a very special thank-you to Lisa Konwinski from the Budget Committee staff who provided extraordinary assistance on the reconciliation bill rules and procedures. I yield the floor, sir.

Mr. MOYNIHAN

Mr. MOYNIHAN. Mr. President, might I join with our distinguished majority leader in expressing the grief we all feel for a man of peace who did so much in his life, and brilliantly, as Director of the Peace Corps under President Bush. We know him so well and miss him so much and can only share in the thought that he rests in peace.

Mr. MOYNIHAN

Mr. MOYNIHAN. I second the motion.

Mr. MOYNIHAN. Mr. President, I yield 1 minute to the Senator from Wisconsin.

Mr. MOYNIHAN. Mr. President, I will exercise a brief 1 minute to describe the Democratic alternative, which is now to be offered.