Pete Stark

Mr. STARK

Mr. STARK. Mr. Chairman, I rise today to oppose the Hefley Amendment to the FY99 Commerce, Justice, State Appropriations bill, which seeks to block the implementation of an executive order prohibiting discrimination based on sexual orientation in the federal civilian workforce. Many Federal civil employers have adopted individual policies prohibiting employment discrimination on the basis of sexual orientation. Executive Order 13087 amends the existing federal executive order governing equal employment opportunity by adding the term ``sexual orientation''--thereby uniting the many existing nondiscrimination policies of Federal agencies. In short, the order extends to gay and lesbian employees the same equal opportunity long-afforded to women, seniors, persons with disabilities, and racial, ethnic and religious minorities. Not only do I oppose this harmful amendment, I believe Congress should take the issue of discrimination in the workplace a step further by passing the long-overdue Employment Non-Discrimination Act. ENDA would provide protection against employment discrimination based on sexual orientation at businesses with more than 15 employees by creating new enforcement rights, such as the ability to proceed before the Equal Employment Opportunity Commission. The need for the passage of ENDA presents itself daily as promotions are rescinded, chances for employment are lost, and harassment on the job abounds. No one should be judged on the irrational prejudice. Congress has no right to prevent these individuals the opportunity to contribute the full measure of their talent and ability to America's workforce. I ask my colleagues to join with me to defend equal rights--and to send the strong message to the majority that discrimination in the workplace based on sexual orientation is wrong.

Mr. STARK

Mr. STARK. Mr. Chairman, I rise today in support of the Mollohan amendment to H.R. 4276, the Commerce-Justice-State Appropriations for FY 1999. The Mollohan amendment removes funding restrictions from the Census Bureau so that they may continue with the task at hand-- providing a fair and accurate Census 2000 for the American people. The goal is clear. The only way to provide a fair and accurate count for the 2000 census is through statistical sampling. The Republican-led Congress insists on full enumeration without the use of sampling. In addition, they are obstructing the success of the entire 2000 census by limiting its funds to only half of the appropriated amount. This in turn may cause irreparable damage to the entire census, leaving an accurate count beyond the realm of possibility. One might wonder why the majority party insists on wasting taxpayer's money to hinder such a vital component of the democratic process. Understandably, the majority party is afraid of losing control over the House of Representatives as we enter a new millennium. Our Founding Fathers intended for population enumeration to provide for fair representation of the American people in the House of Representatives. This did not happen in the 1990 Census and now we must take steps to correct the problem. In the 1990, the Census numbers were over 10 percent in error. This translates to 26 million mistakes. The 1990 Census under-counted 8.4 million people and 4.4 million people were double-counted in the United States. In California alone, 834,516 people were not counted. This was the highest under-count in the nation!! The people of California have been deprived of fair representation for the past eight years. Of the various racial groups, the largest to be under-counted were amongst the Hispanic population with 5% of this group undercounted. In addition, 4.4% of blacks and 4.5% of Indian Americans were under- counted due to errors that statistical sampling can adjust for in the future. The economically disadvantaged and minorities are being excluded from valuable federal programs. Under-counting means millions of federal dollars are lost for California's 13th District as well as for districts across the nation. I am not suggesting we replace direct counting methods with modern statistical techniques. We should, however, supplement direct counting with sampling to ensure an accurate count. Two very reputable groups agree that statistical sampling should be used in the upcoming census. The General Accounting Office and the National Academy of Sciences both endorse statistical sampling to avoid an inaccurate census. Memos from the Department of Justice under both Presidents Bush and Clinton state that the use of sampling is both Constitutional and legal. The only major organization that opposes statistical methods in the 2000 census is the Republican National Committee. Partisan politics cannot play a role in Census 2000. We must prevent the majority party from attempting to strip the American people from their Constitutional right to equal representation. We can start by supporting the Mollohan amendment.

Mr. STARK

Mr. STARK. Mr. Chairman, today I join with Congressman Tim Roemer and Congressman Dave Camp to take a stand for common sense and fiscal responsibility when it comes to our budget. When Congress first approved the International Space Station in 1984, the original price tag was $8 billion. A recent General Accounting Office [GAO] report projects the station's total operating costs at $95.6 billion. Congress keeps throwing taxpayer dollars into this money pit, and we have no tangible benefits to show for it. Since its conception in 1984, the station has been redesigned three times. The latest model would accomplish only two of its eight original scientific missions. Furthermore, many of the remaining goals envisioned for the station could be accomplished aboard unmanned satellites or aboard the space shuttle for a small fraction of the cost. Furthermore, the station's rising costs are a threat to other promising projects. Already, NASA has shifted $200 million from other programs like space shuttle safety and space education grants to pay for station cost overruns. This year, NASA has requested the authority to shift an additional $375 million. As the station experiences more cost overruns, the space station budget will literally consume the NASA budget at the expense of proven programs like probes within our solar system, the Space Shuttle, earth sciences, and aeronautics. Every year we pour billions upon billions of dollars into NASA and the International Space Station at the expense of schoolchildren, the elderly and the infirm. We cannot afford the price of the space station when we have such pressing needs here on planet Earth. If we choose to look to the stars, we must first have our feet planted firmly on the ground.

Mr. STARK

Mr. STARK. Mr. Speaker, this week, our Nation mourns the deaths of Capitol Hill policemen John Michael Gibson and J.J. Chestnut. In the aftermath of the shooting in the Capitol, as Members of Congress reflect on whether this event was avoidable, we must take responsibility for this and other acts of violence attributable to the mentally ill. The Capitol shooting was all too familiar an occurrence, a scene that has been played out in our schools, on our streets, our subways, and in homes throughout America. The movement in the 1970's and 1980's to deinstitutionalize persons with mental disorders was not an unqualified success. It's time that we admit that closing the institutions did not negate the need for further care; the mentally ill still need consistent treatment and many of them are not getting it. Two to three percent of the population experience severe mental disorders. Many more suffer from milder forms of mental illness. In almost every town, we see people on the street whose illness precludes them from working or connecting with other people in a meaningful way. Many of them could be helped with medication and therapy, but only if they had access to care. We must provide that care. We can and must prevent future unnecessary violence so that other families do not have to endure what the Gibson and Chestnut families go through today.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to oppose the vote to override the President's veto of legislation passed by this Congress to criminalize a specific abortion procedure used in catastrophic pregnancies. Make no mistake about it, this is a political vote and a political debate--a debate fraught with inflammatory rhetoric and distorted facts. The fact is, there is no medical procedure called a ``partial birth abortion''--that's a name made up by opponents of choice to distort the issue. What we're talking about is a procedure used in late term catastrophic pregnancies, when the fetus has a horrible abnormality, or the pregnancy seriously threatens the mother's life or health. The vote to override the President's veto of this bill is a blatant attempt to shelter the hypocrisy of the abortion debate--that the strongest opponents of the right to choose also oppose programs promoting comprehensive sex education and birth control, which actually reduce unintended pregnancies. Instead, anti-choice Members of Congress would make access to family planning options more difficult, more dangerous, more expensive, and more humiliating. A vote to override the President's veto would threaten doctors with fines and imprisonment, and prevents not one teen pregnancy. Doctors, not politicians, must decide what medical treatments are the best for these patients. Doctors use this procedure when they believe it is the safest way to end a pregnancy and leave the woman with the best chance to have a healthy baby in the future. Congress should not second-guess their medical judgment. I ask my colleagues in the majority, who often express their disdain at the federal government's involvement in their personal lives, to oppose the veto override. It doesn't get more personal than this.

Mr. STARK

Mr. STARK. Mr. Speaker, I ask unanimous consent that my infirmity not be taken as support for the Republican bill, which is a cynical sham and should be defeated. I wish to announce my support for the Dingell bill. Mr. Speaker, today's vote on managed care reform is a complete sham. It wasn't long ago when the Republican leadership called on their friends in the health insurance industry ``get off your butts and get off your wallets'' to defeat real reform. Today, they are here to put another nail in the coffin of real reform. Their answer to managed care reform is the same as their answer to campaign finance reform and tobacco legislation: Make it look like they are doing something, but then work to kill it with the addition of divisive provisions. H.R. 4250 flunks the fundamental test of real reform--it doesn't hold health plans accountable for their medical decision making. This bill precludes an injured patient or their family from suing a managed care plan that maims or kills them. Under the Republican bill, health plans could continue to get away with cases like that of Mrs. Florence Corcoran, who lost her baby because of her health plan's refusal to follow her doctors' advice. Today, if a doctor commits malpractice on a patient, the patient has the right to sue that doctor. If a hospital maims a patient, they are liable for their action. If a defective car causes a person's death, the care manufacturer is liable. Why should we let managed care plans off the hook? What makes them worthy of legal immunity that we don't grant doctors and hospitals--or any other profession or industry? In addition, the Gingrich managed care bill before us today includes a number of ``poison pills'' that Congress has rejected numerous times in the past. Among the poison pills are: Expansions of medical savings accounts to help the healthy and wealthy at a cost of billions to American taxpayers; MEWA and HealthMart provisions that would destroy small group market reforms in the states, increase adverse selection and weaken state enforcement authority. But the cherry on top of this sundae for the managed care industry is the permission this bill gives health plans to withhold even more access to care than they can under current law. This bill gives HMOs the right to define--each plan for itself--what the medically necessary care is that it will provide to its enrollees. Today, medically necessary care is defined by doctors and other medical experts as the best that science and human ability can deliver. But this bill says plans can decide what their version of medically necessary care is, and how much of it they will give you. It lets bureaucrats, not doctors, determine your health care. Even those managed care reforms where there has been widespread agreement--such as access to emergency care--are botched in the Gingrich bill. This bill does not provide the protections to the private sector that are enjoyed by Medicare and Medicaid beneficiaries today. An emergency physician who testified earlier this week, Dr. Charlotte Yeh, got it right when she said that she thought the Republicans had performed some ``unnecessary surgery on the prudent lay person standard to the point where it is hardly recognizable as the consumer protection we envisioned.'' The Gingrich bill destroys medical record confidentiality. It would trample on Fourth Amendment rights by giving health plans and health providers the right to disclose your medical record to any entity--without your permission. Your medical record, with your name and full history, could wind up in the hands of a drug company's marketing department . . . a credit card company . . . a consultant working on a political campaign . . . a divorce lawyer . . . a newspaper. The public deserves better from Congress than this shoddy piece of work. This bill also allows plans to charge people up to $100 to get external appeals--and doesn't allow patients or doctors to present any evidence at that external appeal review. Talk about a sham! This Republican bill is worse than doing nothing. If Members of Congress took the Hippocratic oath to do no harm, they would not be able to vote for this bill. Vote to defeat H.R. 4250. I support the Ganske-Dingell substitute. It is a real bill, with real protections. The Republican bill is a sham. It provides none of the major consumer protections that patients need. The Republican bill actually does harm. It overrides hundreds and hundreds of State consumer protection laws, leaving people with less protection than they now have. It will drive up the cost of health insurance for most people. It makes your most private medical records available to every Tom, Dick, and Harry salesman. It spends billions on a new tax break for the wealthiest and healthiest in our society. It takes away your right for compensation for pain and suffering because of medical malpractice. These harmful features are poison pills, designed to cause controversy and confusion in the Senate and to prevent a bill from passing. The Republican bill is another testament to the need for campaign finance reform: it is a bill designed to make their PAC contributors happy. The Democratic substitute bill, on the other hand, is a real patient protection bill endorsed by the doctors, by the nurses, and all the consumer groups. It will require that health plans provide you care that is based on the consensus of the latest, best quality of care. The Republican bill, on the other hand, lets each profit-making HMO define what they believe is adequate medical care: they will provide care based on what their accountants tell them--not their doctors. The choice could not be clearer. We can pass the Republican sham bill today--or we can pass a real bill--the Democratic substitute.

Mr. STARK

Mr. STARK. Madam Speaker, I rise today in support of H.J. Res. 121, disapproving the extension of Most Favored Nation, or whatever they now want to call this gift to China. We will hear a good deal today about China's breaking their nonproliferation promises and treaties. We will hear that they were testing a rocket motor while the President was there, with full knowledge, I might add, of our State Department, which now gives China one of two intercontinental ballistic missiles in the world, Russia having the other. We will hear repeatedly about the violation of the Universal Declaration on Human Rights, which China, the PRC, engages in repeatedly. We will also hear from numerous colleagues about the violation and the exploitation of their own labor force, the destruction of young girl children, the imprisonment for slave labor. And we will hear repeated statements of China's unfair trade practices. We will hear that they ignore intellectual property rights with impunity, which means they copy anything they want and reproduce anything they want without paying the fair share for patent or trademarks. We probably will conclude that they do not play by any rules other than their own, U.S. or international rules. And we may conclude, given this inhumane treatment of human beings and complete disregard of the rule of law, that the Chinese Government does not deserve normal trade relations with the United States. We certainly do not recognize Cuba for far less. So we are really treating China specially. Each year the issues around the debate are the same: The Members in this body keep saying we need continued trade, it will help change China's practices. It has not. They have gotten worse. No one can indicate on the floor today that China has improved in any way. But China shows no progress and we continue to accommodate, acquiesce and back off. My colleagues might begin to wonder why. Well, the reason why is that we are here today to bail out General Motors, General Electric, Motorola, Westinghouse and Boeing, the five largest exporters to China. And my colleagues are going to say, well, that is just wonderful. I heard the chairman of the Committee on Ways and Means suggest that we need this to protect the American economy. My distinguished colleague from California suggested there is a vital link. Well, I would agree. And in the words of Ross Perot, this vital link is a large sucking sound. And what we are hearing is the American taxpayers' dollars being sucked right out of the American taxpayers' pockets and awarded to General Motors, General Electric, Motorola, Westinghouse and Boeing. Now, how does this happen? My goodness, Boeing is selling a lot of airplanes. And my colleagues may say, bully, that is an American company, but the fact is there is a hitch. Before Boeing can sell an airplane, Boeing must build a factory in China or China will not let them sell any airplanes. Okay, so they build a factory. My colleagues may say there will be some more jobs. Wrong again. China requires that Boeing hire Chinese people in China. The net result is that we are not creating any new jobs, and we may lose some net jobs as Boeing is attracted to build more than just what they sell in China, but a few extra tail sections for 727s, or whatever they are building over there, because it saves them some money. So the jobs leave and we get no gain there. Well, then one might say, but Boeing is making some money on this and it helps the U.S. economy. Wrong again. The dollars that Boeing makes stay in China. And by staying in China, the taxpayers of America lose. We are not collecting any income tax from Boeing on the money they make and invest in China. That means American taxpayers are being suckered big time. We are paying extra income tax to allow Boeing to take this profit and invest it in China. Well, my colleagues say, maybe some day that will come home. This is not the end. For those of my colleagues who are waiting for the real kicker in this, it is not enough that the taxpayers of the United States are subsidizing Boeing, who are putting the money in China at our cost, we have got to protect them. Not that we have to protect them with a lot of troops, we are going to hear about IMF, which means that now that Boeing and General Motors and General Electric and Westinghouse have all of this money in China, we cannot let the currency be devalued. So the taxpayers, suckers again, hearing that big sucking sound in this vital link, are going to be asked to come up with $18 billion more to protect the money that was already taken out of their pockets to give to Boeing and General Electric and General Motors and Westinghouse to invest in China. It is a sucker game. It is a sucker game by the major corporations in this country who are being subsidized by the American taxpayers to invest in China while we lose jobs in America; while all we get back from China are shelves stocked in our big box warehouse stores so we can buy cheap Nikes and cheap T-shirts as we lose good productive factory jobs, as we lose tax revenue, as we lose our dignity. Because we do all of this while we countenance torture and we countenance turning our back on human rights. It turns all things that Americans believe in on its head and it is wrong. That is what the trouble is. It helps no one but the large corporations in this country. And they are perfectly willing, in the interest of maximizing profits, to ignore the human rights that are so vital to our country's continued existence. So I urge my colleagues to honestly look at the promises made and broken, the PRC's sale of weapons, chemical weapons, nuclear weapon materials, and the growing trade imbalance, and say, why am I doing this? Is it so important to bail out General Motors and Boeing and General Electric and Westinghouse? Have they contributed so much to my campaign that I have to vote to perpetuate this dishonest, immoral regime by subsidizing them with taxpayers' money? I think my colleagues will find, if they examine their consciences, that it is in our interest and the interest of all American taxpayers to support the resolution, and I hope my colleagues will join me in voting to deny Most Favored Nation treatment to China until they decide to join the humane world of man and obey the human rights and the dignity and liberty that we all enjoy. Madam Speaker, I reserve the balance of my time.

Mr. STARK. Madam Speaker, I yield myself such time as I may consume. Madam Speaker, pending the completion of my remarks, I ask unanimous consent that the gentlewoman from California (Ms. Pelosi) be allowed to control the remainder of my time.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to pay tribute to Communications Manager John H. Blank. On July 31, 1998, after 33 years of distinguished service, he will be retiring from the police force in Milpitas, California, in California's 13th Congressional District. Communications Manager Blank began his career serving the Milpitas community in October, 1965. He was sworn in as a police officer on October 1, 1965. He served in the patrol unit until January, 1970 at which time he was appointed as Supervisor of the Traffic Investigation Unit. in 1967, he confounded the Milpitas Police Officer's Association. His concern for the welfare and development of employees of the Department as well as his knowledge and skills in the field of organizational development provided a solid foundation for the Association which continues to serve as an important resource for law enforcement officers today. While serving in the Milpitas Police Department, John continued his education. He was awarded a B.S. degree from San Jose University in 1973 after completing the requirements for a double major in Public Administration and Political Science. Concurrent to his service in the Milpitas Police Department, he also served in the California National Guard. He completed his service in 1971, after attaining the rank of Staff Sergeant. On July 1, 1973, John was promoted to Police Inspector with the responsibility of supervising the Records, Communications and Property functions of the Police Department. Under his supervision, the Department acquired its own dispatching capability and was able to upgrade its services substantially. In April of 1979, as a result of departmental restructuring, John became a Detective Sergeant. His responsibilities included investigating crimes against persons, property crimes, fraud and missing persons. In 1980, John embarked upon a significant career change--he left service as a sworn employee to become a communications dispatcher. In 1985, he became an acting communications supervisor. In 1986, he became permanent supervisor, and, in 1992, he became Communications Manager. As Communications Manager, he managed the growth of this service by improving the size, staff training, and complexity of the Communications Center. He oversaw many improvements during his tenure as Manager, including the change from ``status tags'' to Computer Aided Dispatch, public safety tactical dispatching, and the development of a state of the art Communications Center. He was a co-founder of an organization called C.O.M.A.--the Communications Operations Managers Association of Santa Clara County. C.O.M.A.'s goals are interagency cooperation, support training, and the furtherance of the public safety communications profession. John has always been an active member of the community. He has lived in Milpitas for the last 15 years--in a home that he built himself. He has been a long time member of the Walnut Green Homeowners Association, he founded the Milpitas Tennis Association, has been very active in the Y.M.C.A., and has been a member and president of the Milpitas Kiwanis Club. He is also an active member of his church, serving as both a deacon and usher. John has received numerous awards and commendations throughout his career. He has amassed over forty letter of commendation from citizens, his supervisors, and from a wide variety of governmental agencies. In 1987, he was recognized by the San Jose-Evergreen Community College District for his assistance in the development and presentation of the Basic Public Safety Dispatcher Development Academy. Mr. Speaker, Communications Manager John H. Blank will be honored at a celebration dinner on the occasion of his retirement on August 7, 1998. I would like to thank John for his 33 years of dedicated service on behalf of the residents of Milpitas, CA. His professionalism and dedication will be sorely missed. I wish him luck in all of his future endeavors.

Mr. STARK

Mr. STARK. Mr. Chairman, I rise to support the Lowey amendment to the FY 99 Treasury-Postal Appropriations bill which would require that Federal Employees Health Benefits plans cover prescription contraception just as they cover other prescriptions. The federal program should be a model for private plans and, as an employer, the federal government should provide this basic health benefit for women and their families insured through FEHB plans. However, most FEHB plans limit coverage of contraception, and in some cases cover only one method of prescription contraception, despite the fact that participating plans overwhelmingly cover prescription drugs and clearly recognize them as a key health benefits. Even worse, 10% of plans have no coverage of contraceptives--that is, they fail to cover any of the top five leading reversible contraceptive methods (oral contraceptives, diaphragm, IUD, Depo-Provera, and Norplant. The inadequacy of contraceptive coverage through FEHB plans is clear. A woman covered by the an FEHB plan may be forced to choose a contraceptive method that is not best suited for her medical needs. While there is near universal coverage of sterilization by FEHB plans and reasonable good coverage of oral contraceptives, the percentage of plans covering other specific reversible methods varies dramatically. A total of 88% of plans cover oral contraception, yet only 28% cover the IUD. Thus, plans often do not afford a woman the option of non-hormonal contraception or the choice of the birth control method that may be best suited for her medical circumstances. Some of our colleagues intend to make a spectacle of this issue on the floor. Meanwhile, the health and safety of women seeking contraceptive coverage through their FEHBP is endangered at the hands of the conservative majority. We must not allow this last-minute pandering to the right wing at the expense of women enrolled in FEHB plans, nor must we allow the conservative majority to dictate the birth control methods used by federal employees and their families.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to recognize the Women In Skilled Trades (WIST) program, which is based in Oakland, California, on the occasion of its 10th Anniversary. Since its inception, this outstanding program has trained over 300 women for well-paying jobs in the construction industry. WIST was established in 1988 by the Oakland Private Industry Council in order to provide economically disadvantaged women, displaced homemakers, and dislocated workers with high quality pre-apprenticeship training. The program offers an excellent solution for women seeking to achieve economic self-sufficiency and to serve as role models for their children. The pool of well-trained, motivated workers that graduate from the program is a benefit both to area employers as well to our community. The WIST program is a nationally acclaimed model for nontraditional training programs, with a comprehensive training curriculum and dedicated instructors and staff. It is also an outstanding example of how a partnership of public, private, and non-profit entities can work together to affect positive change in the lives of women and their families. On Monday, July 20, 1998, the Women in Skilled Trades program will be celebrating its anniversary in Oakland, California. I hope my colleagues will join me in recognizing the achievements of this organization. I would also like to commend the many women who have graduated from the WIST program. I look forward to ten more years of progress!

Mr. STARK

Mr. STARK. Mr. Chairman, I rise today in support of the Sanders amendment to H.R. 4104 which prohibits financial loans, guarantees, or other obligations from the Exchange Stabilization Fund (ESF) in the U.S. Treasury unless authorized by the U.S. Congress. Congress must have a say in how billions of taxpayer dollars are distributed worldwide. Under the current system, the administration is given a blank check--in the form of the ESF--to bailout failed economies in developing countries. This blank check, however, has been used to support irresponsible, and undemocratic international economic policy. Congress needs to gain leverage so that it can force the administration to abandon short-sighted goals and unequitable practices. The ESF has evolved from a fund with a specific mission to an unaccountable giant nourished by tax dollars. Created by President Roosevelt under the Gold Reserve Act, the ESF was intended to be used to stabilize the exchange value of the dollar. The billions of dollars recently taken from the fund to bailout Asian countries and the $12 billion loan to Mexico in 1995 fall way outside of the realm of the ESF's original mission. A fund that no longer fulfills its original Congressional directive must be made accountable once again. In addition to serving a financial purpose, ESF loans symbolically demonstrate American support for regimes, such as the Mexican regime that was bailed out in 1995. Loans with such international political and economic significance should require more than just the Administration's backing. The ESF currently has no direct accountability to the American people. It is unwise for these funds to be distributed without Congressional approval. Each year on this floor we debate appropriations worth millions of dollars. We are shirking our responsibility to the American people by accepting unilateral executive appropriation of billions of dollars every year from the ESF to developing countries. Congress needs to be able to voice the American people's concerns over the use of the ESF. And Mr. Chairman, I have many concerns over the projects that the ESF is currently supporting. These concerns have a direct bearing on the lives of the hard-working people back in my district. ESF loans are part of an international tax and transfer cycle that rescues irresponsible risk-taking international banks at the expense of American and foreign middle and lower-income taxpayers. The short-term economic recovery promoted by ESF bailouts, not to mention U.S.- subsidized IMF structural adjustment, ignores long-term economic and political instability. Instead of learning to make more sound investments, banks continue to take risks knowing that they have a safety net. As a result there is a cycle of debt and rescue, subsidized by U.S. taxpayers. It is outrageous for wealthy international financiers and industrial moguls in developing countries to be saved time and time again by the hard-working people of America. Congress needs to have the power to control the ESF so that lasting democratic regimes can be established and strengthened in countries benefiting from ESF funds. Under the present system, the ESF guarantees the solvency of insolvent institutions and unjust governments by continually bailing them out of crisis. The use of the ESF to support dictators in countries like Indonesia makes it obvious that Congress is needed to guarantee that the U.S. helps spread democracy and not corruption around the world. Mexico in 1995 is a case in point in the use of the ESF to support corruption. The Mexican government purchased more than $45 billion of bad debts from Mexican banks in 1995 with the aid of $12 billion in ESF loans. Despite promising to eventually hold borrowers liable for the debts, the government has permanently absorbed the debt burden, agreeing to rescue the very financial elites that control the government. The likely result is that the $45 billion will be directly transferred from Mexican and American taxpayers to the politically and economically elite in Mexico, accentuating the class divisions that plague that society. Congress must have the power to insure that ESF loans are not given to countries that perpetuate corrupt political and economic regimes, such as Mexico. ESF loans are part of a larger pattern of irresponsibly short-sighted international financial bailouts subsidized by U.S. taxpayers. Currently members can voice their feelings about funding for the IMF and other multilateral development banks. We deserve to also have our voice heard on the appropriation of billions of tax dollars to foreign countries through the ESF. I strongly urge my colleagues to support the amendment.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today with a number of my colleagues to introduce ``The Medicare+Choice Cold-Calling Prohibition Act.'' This bill would prohibit unsolicited telemarketing sales of new Medicare+Choice health plans to Medicare beneficiaries. Under the new Medicare+Choice program developed in the Balanced Budget Act of 1997 (BBA), Medicare beneficiaries will no longer have only a choice of traditional Medicare or HMOs. Seniors will now get to choose among an alphabet soup of additional options such as PPOs, PSOs, POSs, Private FFS, and MSAs. All of this would undoubtedly lead to real confusion. Adding to that confusion will be the fact that many more private health insurance programs will be competing to capture large segments of the Medicare population. The Balanced Budget Act of 1997 recognized the power of these insurance advertising budgets to sway seniors into decisions that may not be in their best interest. The law requires that marketing materials be submitted to the Health Care Financing Administration (HCFA) for review and that fair marketing standards be followed that prohibit cash or monetary rebates as an inducement to enroll. HCFA's proposed regulation for implementing the BBA go even further. They prohibit insurance companies from marketing their products door- to-door, forbid misleading activities in marketing practices (such as intimating that the government endorsed their plan), and the plans must market to the disabled population as well as seniors. While all of these protections are good, they don't go far enough. In addition to adding new managed care options to the Medicare program, the BBA greatly enhanced the ability of states to enroll their Medicaid populations in managed care. The marketing protections for Medicaid enrollees actually go further than those for Medicare beneficiaries. The BBA ensures that managed care plans ``shall not, directly, or indirectly conduct door-to-door, telephonic, or other `cold-call' marketing of enrollment under this title.'' So, our Medicaid population is protected from becoming prey to telemarketers whose paychecks depend directly upon the number of healthy risks that they sign up for the plan. Unfortunately, our nation's Medicare beneficiaries are not protected from telemarketers. And, we know the senior population is especially vulnerable to a well-honed health insurance sales pitch. Many of you will recall the evidence we uncovered in the late 1980's that pushed us to enact standardized Medigap policies and to prohibit the sale of duplicative policies. We found seniors who were literally paying for a dozen Medigap plans--most of which covered the exact same benefits! And, a dozen policies for one individual wasn't even the most egregious of the examples. That's why we rise today to introduce the Medicare+Choice Cold- Calling Prohibition Act''. This bill does exactly what its title indicates--it would protect our seniors from being inundated with unwanted sales pitches. It provides the same protections granted to our Medicaid recipients to Medicare beneficiaries. The BBA Medicare changes are significant--the most significant changes made to the program since its inception in 1965. It is important that Medicare beneficiaries learn as much as possible about these changes and make sure that the choices they make are in their best interest. The unfortunate reality is that we know from past practices that telemarketers will not be looking out for seniors' best interests. They will be looking out for making the biggest commissions possible. That's why passage of the Medicare+Choice Cold-Calling Prohibition Act is so important.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to congratulate Mr. Jack Allen of San Leandro and his wife Elsie on their 50 years of marriage. In our community, Jack is a hero, and rightfully so. Jack labored persistently for twelve years to get a stamp to commemorate Juan Cabrillo, the Portuguese explorer of Alta California over 450 years ago. His efforts resulted in the Juan Cabrillo commemorative postage stamp that was finally approved by the Postal Service in 1992. The stamp was a symbol of the importance of the Portuguese settlers to our founding nation. Jack's actions in our community through the Cabrillo Clubs continue the Portuguese-American contributions to our country through the clubs' charitable and education work. Jack has demonstrated his loving commitment in another area, his marriage to his lovely wife, Elsie. We salute Jack and Elsie as they celebrate their 50th wedding anniversary.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to introduce the Medicare+Choice Pharmaceutical Management Act of 1998. This bill would provide important protections for Medicare beneficiaries receiving prescription drug benefits through Medicare+Choice plans. These plans would be required to disclose important information about how they manage their drug benefits to cut costs, including any incentives offered to doctors to get them to switch to cheaper, but sometimes less effective, medications. While many health plans still manage their own drug benefits, an increasing number of plans are hiring a new breed of management consultants known as pharmaceutical benefit managers (PBMs) to do their work for them. These companies currently manage prescriptions for some 115 million Americans and the number is expected to reach 200 million by the year 2000. Plans have turned to PBMs in the hopes that they will be able to cut rising prescription drug costs. PBMs accomplish that goal by setting up lists of approved drugs (known as formularies), requiring specific authorization of non-formulary drugs, and urging doctors--often by providing financial and other incentives--to switch prescriptions for less expensive medications. Of greater concern is the fact that PBMs are often given free reign to manage benefits through their own programs, with little oversight from the health plan. And, PBMs are neither licensed health care providers nor subject to federal regulation by the Food and Drug Administration (FDA). Several of the largest PBMs are now owned by drug manufacturers and many independent PBMs have formed ``strategic alliances'' with drug manufacturers, exchanging preferential treatment on a formulary with millions of dollars in rebate payments from the drug companies. Since 1993, the three largest PBMs, serving fully 80% of covered enrollees, have been acquired by drug manufacturers at a total cost of $12.8 billion. And, a January 1998 study showed that drug-company-owned PBMs covered 41% of the lives enrolled in PBM programs. Drug companies that ow PBMs say that they have ``firewalls'' in place to prohibit the two companies from sharing proprietary information or conducting joint marketing efforts and other deals that benefit the drug company. But can any company policy resolve this inherent conflict of interest, especially when the goal is to maximize profit? If you've the CEO of a major drug company, wouldn't it be tempting to try to get more doctors to prescribe your company's new medication for high blood pressure? I certainly think so. But, in case you think I'm just being cynical, consider the case of PCS, the largest PBM covering 50 million lives. When PCS was acquired by Eli Lilly, which manufactures Prozac, in 1994, Lilly's chairman openly declared that ``this purchase will help us sell even more Prozac.'' Internal PCS memos obtained by the New York City Public Advocate revealed a plan to steer the company's managed care customers toward Prozac and another top Lilly drug, the ulcer medication Axid. Millions of messages would be sent to physicians and pharmacists urging switches, leading to a projected $171 million in additional sales. Given that there are millions of dollars at stake for drug manufacturers and PBMs, it's very tempting for these companies to join forces to steer physicians to prescribe their products. But, there's more at stake than just money--the health and welfare of Medicare beneficiaries who join Medicare+Choice plans is also at risk. I am attaching testimony given by the Public Advocate for the City of New York before President Clinton's Advisory Commission on Consumer Protection and Quality that clearly shows just how low these companies will go to push their products. I have introduced the Medicare+Choice Pharmaceutical Management Act of 1998 to discourage these types of activities by requiring Medicare+Choice plans to disclose the following information about their pharmacy benefits management: the committee (if any) used to develop and oversee drug formularies, including the composition of the committee and how they decide what drugs to include on the formulary; and incentives to physicians, pharmacists, and patients associated with formulary compliance programs, including drug switching and any known health risks associated with such a program; all policies and procedures for any drug utilization reviews of physicians and pharmacists, including any counseling, intervention, enforcement actions, or penalties associated with these reviews; any expedited process for amendment drug formularies to include new drugs that become available, particularly those that treat or alleviate potentially life- threatening illnesses; and any requirements for prior treatment failures of a particular drug before approving alternative drug therapies. Medicare+Choice plans will be required to disclose this information when they apply for a contract with Medicare and to make this information and their drug formularies available to the public upon request. That way, the Health Care Financing Administration (HCFA), the agency that reviews these contracts, will know about a health plan's pharmacy program--and any financial incentives to push certain drugs-- and can make the decision whether to contract with that plan or require changes in their pharmacy benefits management. And, even more important, the information will allow consumer groups and individuals to make recommendations and choices about the managed care plans that best serve the patient. I urge my fellow Members of Congress to join with me in cosponsoring the Medicare+Choice Pharmaceutical Management Act of 1998. Together, we can ensure that Medicare beneficiaries get access to the prescription drugs ordered by their physician, not by a benefits manager focused on the bottom line. Testimony of mark Green, Public Advocate for the City of New York, Before the Advisory Commission on consumer Protection and Quality in the health Care industry--February 26, 1998 We all know that there is no more common health care experience in America than filling a prescription. But few Americans know that the terms of our every day drug-counter transactions are changing more fundamentally and rapidly than anytime in modern medical history. I suggest that your report to the President reflect this fact and propose reforms that protect patients from the adverse consequences of ``drug switching.'' A two-year investigation by my office has concluded that health plans are now frequently intervening in the prescription process, pressuring physicians and pharmacists to switch medications to less therapeutically valuable drugs. In addition, the approved ``drug formularies'' sometimes exclude critical drugs from coverage altogether. These preferences seldom have anything to do with medical appropriateness. Indeed, for some individual patients, the substituted drug is not as efficacious as the original prescription and can lead to harmful side effects. While the original intent of these now widespread substitution strategies was to lower costs without affecting the quality of care, existing research indicates that this practice results in higher overall costs. Instead of cost- containment, commercial interests have become the guiding force behind drug preferences. Health care organizations have established a variety of business relationships with drug manufacturers that are shaping, and in some cases compromising, drug choice. The exposure of these arrangements has sounded a sudden alarm among those concerned abut the independence and trust implicit in the prescription tradition of American medicine. Five federal agencies have weighed in critically on the drug switching issue in the last few years: the FDA [US Food and Drug Administration], the OIG [US Office of the Inspector General], the HCFA [US Health Care Financing Administration], the FTC [US Federal Trade Commission] and the GAO [US General Accounting Office]. The FDA recently issued draft guidelines to attempt to monitor these practices. Yet it is estimated that 71 percent of HMOs will have programs encouraging substitutions by the end of the year. The American Medical Association says that the ``frequency and intensity'' of HMO substitution interventions ``pit the interest of patients against the economic interest of their health care providers'' and have risen ``to the level of harassment.'' The American College of Cardiology argues that heart medications are highly specific to particular patients and warns that substitutions represent ``a real and present danger'' that could involve patients being switched to drugs that might produce ``life threatening toxicity'' or other adverse reactions. My own surveys of almost 400 New York physicians and pharmacists found that 75 percent of both believe substitutions are diminishing care, while almost all said plans routinely contact and urge them to make substitutions. Recent academic and governmental reports have concluded that both the employer groups paying the premiums and the HMOs engaging in drug management tactics are becoming increasingly concerned about the care-consequences of these switches. Fourteen medical journal articles have reached critical conclusions, six of which suggested that these new drug preference practices may be leading to extended illness, more visits to doctors and emergency rooms, longer hospital stays and greater total costs. What has galvanized this concern is the growing power of a new force in drug selection--PBMs [pharmaceutical benefit managers]. HMOs retain PBMs as consultants to help them administer drug coverage. These companies, which have overnight become billion dollar giants in their own right, manage prescriptions for 115 million Americans. They are the engines driving the new substitution initiatives. With 90 percent of HMOs now employing one form or another of pharmacy management, 200 million Americans are expected to be covered by PBMs by the end of the decade. Though the initial rationale for turning over drug management to PBMs was cost containment, drug costs continue to increase as a share of total health costs and faster than inflation. Indeed, drug costs have risen from $21 billion ten years ago to $50 billion today, and ambulatory costs for drug-related problems, including reactions to PBM-induced substitutions, are how estimated at $76.6 billion. PBMs develop the formularies, a list of covered and preferred drugs, thereby determining prescription access for millions of patients. They pay incentives to pharmacists to get them to push doctors to switch prescriptions, and drop independent pharmacists who do not engineer switches often enough. PBM consultants call and visit doctors to discuss specific patients and urge the use of specific drugs. They impose rock-bottom prescription budgets on doctors, and review the prescribing records of recalcitrant physicians to make sure they make the favored drug selections. They even punish patients who do not accept switches by charging them higher co-pays. Yet PBMs are neither licensed as health care providers nor regulated by any oversight agency. But PBM drug preferences are frequently of questionable independence. Since 1993, the three largest PBMs, serving fully 80 percent of covered enrollees, have been acquired by pharmaceutical manufacturers at a total cost of $12.8 billion. Other manufacturers have formed ``strategic alliances'' with major PBMs, paying millions of dollars in rebate payments for preferential treatment on a formulary. The overarching corporate purpose of these acquisitions and arrangements has clearly been to increase market share for certain widely used drugs. Studies have shown, for example, that the manufacturer-owned PBMs are unsurprisingly pushing the prime pharmaceuticals of their owner. PCS, for example, is the largest PBM, covering 50 million lives. It was acquired by Eli Lilly, the manufacturer of Prozac, in 1994. Lilly's chairman openly declared after the PCS merger that ``this purchase will help us sell even more Prozac.'' Internal PCS memos obtained by my office revealed a plan to steer the company's managed care customers toward Prozac and another top Lilly drug, the ulcer medication Axid. Millions of messages would be sent to physicians and pharmacists urging switches, leading to a projected, almost instant, burst of $171 million in additional sales. Yet both drugs cost more than effective competitors'. PCS hired outside experts to justify the Prozac switch. Though only one of the three consultants recommended knocking a top competitor, Zoloft, off the preferred list, PCS did it anyway. In fact, the one consultant they followed found that Prozac had the longest dose adjustment time of three main antidepressants--two and a half months compared to Zoloft's five and a half days. The consultant also found that Prozac produced far more side effects, including headaches, sexual dysfunction, insomnia, diarrhea, anxiety and agitation. Yet the PCS letter subsequently sent to thousands of physicians erroneously suggested that Prozac had the shortest adjustment time and fewest side effects. The misuse of this PCS drug utilization letter for transparent promotional purposes was one of the reasons the FDA recently decided to monitor drug substitutions. HCFA recently reported that PCS believes that 30 percent of the prescriptions written under its preferred drug program are successfully switched, providing some measure of how extensive this practice is becoming. Such drug policies influenced by commercial interests can have damaging effects on care. Patients are being switched to chemically dissimilar agents that are not rated as equivalent by the FDA, and usually have different side effects, dosages and efficacy rates. Patients stabilized on one medication are also being moved to another without any clinical cause, leading one doctor to label these switching strategies ``massive unfunded human experimentation.'' With doctors constrained by preferred lists, the many differences between patients--age, ethnicity, multiple disease states--are not always factored into prescribing decisions. Hurt most by these practices are the elderly and chronically ill because they often consume daily dosages of a variety of highly competitive medications. Take the example of 65-year-old Clara Davis, a retired grocery store manager from Bolivar, Tennessee. She lost a third of her stomach after her ulcer medication was switched. Her physician tried to persuade her plan not to force the substitution but it insisted. While recovering from the operation she suffered a paralyzing stroke. As we meet, several states--Maine, New York, California and Virginia--are considering legislative action to protect the Clara Davis' of this country and to restrict drug formularies based more on commercial, rather than health, considerations. But ultimately, since drug sales are obviously national in scope, there must be a national policy on drug substitutions. I urge you not to squander your once-in-a-generation opportunity to stop this new and growing trend of HMOs--not physicians and pharmacists--prescribing the pills that we all swallow. Given how extensive and harmful managed-care-driven drug substitutions have become, I urge the Commission to include this language in their final report. I believe that these recommendations implement the mandates of the Consumer Bill of Rights on Information Disclosure and Participation in Treatment Decisions: ``Consumers should be fully informed about all factors affecting a prescription choice. Health care organizations and physicians should disclose any possible side effects or economic reasons for a recommended therapeutic switch. Health care organizations should restrict substitutions to those that are found to be therapeutically equivalent by the FDA. Consumers should be free to reject these recommended switches without penalty, such as the imposition of a higher co- payment. Consumers have the right to continue on a drug regimen that has been medically beneficial for them, without pressures on their physician to switch. Health care organizations should make their preferred drug lists, as well as formularies, available to consumers. Drug substitutions should take into account the potential overall cost of a change in care, not merely the comparative costs of two medications in the same therapeutic category. ``The President should provide strong, continuous leadership to improve the quality and delivery of prescription drug care in the United States. The President should act to eliminate all commercial interests advising, selecting or influencing prescription drug treatments and act to improve the health of all Americans by developing a patient-specific prescription drug policy.'' references Scientific Studies and Reports 1. Bloom BA, Hacobs J: ``Cost-effects of Restricting Cost- effective Therapy.'' Med Care 23:872-80, 1985. 2. Bootman JL, Johnson JA: ``Drug-Related Morbidity and Mortality: A Cost-of-Illness Model.'' Arch Intern Med 155:1949-56, 9 Oct. 1995. 3. Cromwell DM, Moore RD, Steinberg EP, et al.: ``Florida's Restrictions on Reimbursement for Peptic Ulcer Disease Drugs Associated with Increased Hospitalizations.'' Presented at the First Annual Research Service Award trainees Research Conference. Chicago; 3 June 1995. 4. Etheredge L: ``Pharmacy Benefit Management: The Right Rx?'' In: Research Agenda Brief, from a discussion by the George Washington University National Health Policy Forum. Washington DC; 21 May 1995. 5. Horn SD, Sharkey PD, Tracy DM, et al.: ``Evidence of Intended and Unintended Consequences of HMO Cost Containment Strategies: Results from the Managed Care Outcomes Project.'' Am J Man Care 2:253-264, 1996. 6. Krelig DH, Knocke DJ, Hammel RW: ``The Effects of an Internal Analgesic Formulary Restriction on Medicaid Drug Expenditure in Wisconsin.'' Med Care 27:34-44, 1989. 7. Levy RA, Cocks D: ``Component Management Fails to Save Health Care System Costs: The Case of Restrictive Drug Formularies.'' Washington DC: National Pharmaceutical Council 1996. 8. Magid D, Douglas JM, Schwarz JS: ``Doxycycline Compared with Azithromycin for Treating Women with Genital Chlamydia Trachomatis Infections: An Incremental Cost-effectiveness Analysis.'' Annals of Intern Med 124-389-399, 1996. 9. Moore JM, Newman R: ``Medicaid Drug formularies: Opening Closed Doors.'' Washington DC: American Legislative Exchange Council 1990. 10. Schulman KA, Rubenstein LE, Abernathy DR, et al.: ``The Effect of Pharmaceutical Benefits Managers: Is It Being Evaluated?'' Annals of Intern Med 124:906-913, 1996. 11. Shulman SR, DiCerbo PA, Ulcickas ME, Lasagna L: ``A Survey of Therapeutic Substitution Programs in Ten Boston Area Hospitals.'' Drug Info J25:41-52, 1992. 12. Sloan FA, Gordon GS, Cocks DL: ``Hospital Drug Formularies and the Use of Hospital Services.'' Med Care 31:851-867, 1993. 13. Smalley WE, Griffin MR, Fought RL, et al.: ``Effect of a Prior-authorization Requirement on the Use of Nonsteroidal Antiinflammatory Drugs by Medicaid Patients.'' N Engl J Med 332:1612-7, 1995. 14. Soumerai SB, Ross-Degan D, Fortess EE, Abelson J: ``A Critical Analysis of Studies of State Drug Reimbursement Policies: Research in Need of Discipline.'' Milbank Quart 71 (2):217-252, 1993. 15. Soumerai SB, McLaughlin TJ, Ross-Degan D, Casteris CS, Bollini P: ``Effects of Limiting Medicaid Drug-reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia.'' N Engl J Med 331:650-655, 1994. 16. Soumerai SB, Lipton HL: ``Computer-based Drug- utilization Review: Risk, Benefit, or Boondoggle?'' N Engl J Med 332:1641-5, 1995. Federal Government Agencies-- United States Food and Drug Administration 1. ``Guidance for Industry: Promoting Medical Products in a Changing Healthcare Environment; I. Medical Product Promotion by Healthcare Organizations or Pharmacy Benefits Companies (PBMs)''. Docket No. 97D-0525) 1998. United States General Accounting Office 1. ``Pharmacy Benefit Managers: Early Results on Ventures with Drug Manufacturers'' GAO/T-HEHS-96-85 (Nov. 1995). United States Health Care Financing Administration 1. ``Assessment of the Impact of Pharmacy Benefit Managers.'' HCFA-95-023/PK (September 30, 1996). United States Office of Inspector General 1. special fraud alert issued by OIG (August 1994). 2. ``Experiences of Health Maintenance Organizations with Pharmacy Benefit Management Companies.'' OIG-01-95-00110, April 1997. State Attorneys General 1. In the Matter of the Upjohn Company: Assurance of Discontinuance/Assurance of Voluntary Compliance. Entered by the State Attorneys General of Arizona, Iowa, Minnesota, Missouri, New York, North Carolina, Texas and Wisconsin, July 1994. Medical and Healthcare Groups 1. American College of Cardiology: ``Position statement: Therapeutic substitution.'' 22 Feb. 1988. 2. American College of Physicians: ``Position paper: Therapeutic substitution and formulary systems.'' Annals of Intern Med 113-160-2, 15 Jul. 1990. 3. American Medical Association: ``AMA policy on drug formularies and therapeutic interchange in inpatient and ambulatory patient care settings.'' Am J Hosp Pharm 51:1808- 10, 1994. 4. American Pharmaceutical Association: ``Statements at the Food and Drug Administration's Hearing on Pharmaceutical Marketing and Information Exchange in Managed Care Environments.'' 19 Oct. 1995. 5. National Association of Chain Drug Stores: Petition to the Federal Trade Commission (12 Jun. 1996). Legislative Initiatives 1. California Senate Bill 625 (Senator Rosenthal), passed the Senate, in the House. California Assembly Bill 1136 (Assembly member Brown), passed in Senate and House, died in Conference Committee, Nov.30, 1996. 2. New York State Assembly. Hearing held by the Standing Committees on Insurance and Health, New York City: May 1, 1997 3. Virginia Senate Bill No. 1114, as amended, 1997. Litigation 1. Pfizer v. PCS, No. 96-126154 (S.D.N.Y. filed Oct. 1995).

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to introduce the Medicare Contracting Flexibility Act of 1998. For years, we have been telling the Health Care Financing Administration (HCFA) to be a more prudent purchaser of health care. Now, we need to provide them with the tools to act more like a private company and hold Medicare contractors accountable. Specifically, the Medicare Contracting Flexibility Act would enable HCFA to contract with other types of companies besides health insurers to process claims for the Medicare program. Right now, the pool of potential contractors is limited and has been steadily diminishing, leaving HCFA at the mercy of the few contractors that remain. If one fails or has difficulty processing claims, HCFA is hard-pressed to find a replacement. This problem is especially evident in HCFA's inability to bring its contractors into compliance for the year 2000. Although several contractors are not yet in compliance, HCFA appears to have little leverage in forcing contractors to make the necessary system adjustments. This means that January 1, 2000, Medicare's claims processing system could malfunction, wreaking havoc throughout the provider community. The Medicare Contracting Flexibility Act would enable HCFA to solve this short-term problem by expanding the pool of potential contractors and fostering more competition among companies so that HCFA could get the best value and service for each taxpayer dollar spent. The Medicare Contracting Flexibility Act would also give HCFA the ability to solve long-term problems by laying the groundwork for other changes to the contracting program. For example, HCFA could set performance standards for contractors, or combine claims processing for Medicare Parts A and B under one contractor, as opposed to having two separate entities. All of these changes would translate into better, more effective service for the Medicare program, and ultimately the nation's 39 million Medicare beneficiaries. I urge my fellow Members of Congress to join with me in passing the Medicare Contracting Flexibility Act. Together we can ensure that HCFA has the tools to be a more prudent purchaser of health care.

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to commend Chairmen Jeffords and Bliley for conducting hearings on the problem of organ allocation. As they well known, organs have not been allocated in a fair way to benefit patients in the past and we are in a position now to take a stand for patients and for fairness. This is a simple issue of fairness and quality. If you are a patient in need of a transplant and you live in Tennessee, the average time you spend on the waiting list is about 21 days. If you live in my part of the country, the San Francisco Bay Area, the average waiting time for that same patient is over 300 days. In every part of the country, the Cleveland Plain Dealer reports that minority candidates wait longer than their white counterparts for available organs. Is this fair? When my good friend Congressman Moakley was diagnosed with hepatitis B and was in need for a liver transplant, his doctors told him to leave Boston and move to Virginia to increase his chances of obtaining a liver. Fairness is half of this fight. Quality is the other. There is a lot of money to be made in organ transplants. Too many centers have been opened to increase the prestige and the profits of a local hospital-- and not because they do a good job. In fact, in general the lower volume small transplant centers have poorer outcomes than the high volume transplant centers. The fact is, having a transplant center has become the equivalent of health pork. Many of these centers are like the excess projects in the recently-passed highway bill: centers without a justification. But unlike highway pork, these centers often end up killing patients because they do not do as good a job as the high volume centers. I really think it is immoral for centers who have a lower success rate than the high volume centers to be fighting the Department's regulation. Their actions are a disgrace to the Hippocractic Oath. The proliferation of poor quality transplant centers not only wastes lives, it wastes money. The United States has 289 hospitals doing transplants--and that is an enormous commitment of capital. I have read that a hospital has to invest about $10 million to be able to do heart transplants. These proliferating costs are part of what drives health inflation in the United Sates and part of what places such huge budget pressures on Medicare. Concentrating transplants in fewer, high-quality, life-saving centers would allow us to save hundreds of millions of dollars in the years to come. The Department's regulation gives us the potential to focus on Centers of Excellence where we not only save lives, but can obtain economies of scale necessary to preserve the Medicare program. If my colleagues are serious about putting patients first, what is so onerous about a system that proposes to base transplant decisions on common medical criteria on a medical need list--not geography, not income, not even levels of insurance coverage--just pure professional medical opinion and medical need. This hearing is about putting patients first--not putting transplant bureaucracies first. I can think of no better way to put patients first than to make the system fair for all. I urge the Committees to support the Department's regulations.

Mr. STARK

Mr. STARK. Mr. Speaker, I thank the gentleman for yielding me this time. We have talked today about the asininity of this bill, the sheer folly, the sophomoric sort of approach. I guess I would remind the people that it is the Republicans that shut down the government several times because they were unable to come up with a budget. I would challenge any Republican who has an idea, much less an idea of what they would do just in the oft chance they fail to come up with a bill. And even if they were to come up with a bill, they are not telling us what happens, say, in health care, an issue which they postulate a good bit about and posture about. The Armey flat tax bill, which they might choose, imposes tax penalties on employers that provide health care benefits to their employees. The Tauzin retail sales tax bill imposes a sales tax on people when they pay for health insurance and health care. I wonder if that is what they intend to do. The Republicans voted to increase the rate at which self-employed people could deduct their health care. This will end that. I presume that they really do not care, as they have not in the past, about providing health care to the 45 million uninsured. I am sure that they do not want to help employers pay for it, because I think they are indifferent. I am not sure that anyplace in the King James version of the Bible it suggests that employers should pay for health care benefits or that we should insure people. Therefore, some Republicans will tend to ignore the suffering that people have for lack of health care. The basic fact is that this is sheer irresponsibility, obviously drafted by people with no understanding of business or the Tax Code or economics, some things that are important to having the country's economy function. One of the things that many of my colleagues on the Republican side have been very assertive of is States rights. But what they do not understand is that this would also destroy many States' ability to raise any revenue. Many States that have an income tax parallel or mirror the Internal Revenue Code. And if in fact, as their bill suggests, we would stop collecting funds in the year 2002, we would, therefore, put these States out of business. And we would not have, obviously, any Federal money to support them. So they are impacting many States. The unintended consequences of this bill are legion. So that I want to remind my friends and colleagues that no one suggests that we should not reform the Tax Code. The last major reform was led by Ronald Reagan, at his insistence. Much of what is stacked over on that table was Ronald Reagan's suggestion, which we passed. And it was not a bad bill, I might add. Now, we have no bill and we have a nonsensical campaign bumper sticker, and I hope we vote it down and do not see this kind of embarrassing legislation brought again.

Mr. STARK

Mr. STARK. Mr. Speaker, I thank the gentleman for yielding me this time. Mr. Speaker, the distinguished gentleman from Illinois makes excellent points. I would agree with him that the Tax Code could be more fair and should be more fair; that the burden should be redistributed; that the marriage penalty is something that should be adjusted, taking into account the new structure in families. And that may well get done, if the Republican leadership decides to let it get done and bring it to the floor. I have serious doubts about their ability to do that. But if they do, they would receive a lot of support from this side. Now, having said that, the bill under discussion, if we did reform the marriage tax penalty, would completely negate that. If we made the Tax Code more fair, this silly bill that is under discussion would completely eliminate that. My colleagues may say, yes, we must set a time. Look at the experience under the Republican leadership, Mr. Speaker. In 1994, the Republicans shut down the government, not once but twice, because the Republicans could not even agree on a budget. Now, imagine rewriting the entire Tax Code at a time when the government is shut down. No money. Do we have any faith that the Republican leadership that has brought government to a standstill twice in their tenure, that has waited 28 years for a balanced budget, could get the Tax Code revised? They cannot solve the marriage penalty, they cannot get anything done, they cannot protect people in managed care from the greedy insurance companies, they cannot punish the tobacco companies. The Republicans have shown no ability to get their act together. Why would anyone in their right mind think that they could put together a tax bill in its entirety when they cannot bring one to the floor now? So their way is to destroy the government. Shut it down, again and again. This time, if we shut down the government for the lack of a Tax Code, it will be gone for a long time. I urge my colleagues to think through the seriousness of this, the capriciousness, the irresponsibility, the childishness of bringing forth a bill which could destroy the government. And it certainly destroys what little, if any, credibility the Republican leadership of this House might have with the American public. They are inept and unable to run this Congress or bring forth bills that will help the country and, in so doing, they show their ineptness, their impotence to pass legislation by saying if we cannot do anything, let us set a time limit. My children, Mr. Speaker, when they were unhappy, used to say, ``I'm going to hold my breath and die if I don't get an extra bit of desert.'' Well, let us let the leadership hold their breath and see what happens. I urge a ``no'' vote.

Mr. STARK

Mr. STARK. Mr. Speaker, I had intended to speak later today on an issue of professionalism in the House of Representatives. It has seemed to have departed in 1994. The House is now, unfortunately, being run by amateurs who have really no concept of what legislation does in its far-reaching effects. A perfectly good example is this bill before us. While I happen to differ with the distinguished gentlewoman about the best way to support education, I respect her right to her opinions as to what will increase benefits to our children. The fact is that the gentlewoman's leadership has got this place so convoluted that her distinguished efforts today will not make any difference. My chairman of my subcommittee on which I serve, the gentleman from California (Mr. Thomas), recently referred to a lot of Republican legislation as asinine. He was not just whistling Dixie. I want to suggest to the gentlewoman that a little later today, the gentlewoman is going to vote for a bill which will absolutely negate this bill that she is now proposing. Which does the gentlewoman want to do? Would she like to help parents with their savings account, as she so eloquently purports to do? Then I propose that the gentlewoman would join me in opposing the bill that her party will bring to the floor today, which will absolutely suspend the entire income tax system in 2002 and, therefore, make her bill useless, meaningless. Not only will it make the gentlewoman's bill useless, she will probably not have any schools, because not only will sunsetting the income Tax Code mean that no longer will the public be willing to buy tax exempt bonds, because who knows whether, in fact, they will be tax exempt or taxed or how high they will be taxed; no longer will the public be willing to give, to donate to their church, because they are not sure whether that will be taxed or not. As a practical matter, we had better hurry up and die before the year 2002 or our wills will not be any good. All of the plans that the financial markets make, and I do not know if there are any Republicans who deal with the financial markets, I think these tax plans have all been designed in football huddles. But aside from that, had any of them studied economics and had any of them had any awareness of the implications of what abolishing the Tax Code would do? I have no quarrel that some people may pay too much tax; some people may pay too little in tax. Some people may not like cigarette taxes. Some people may not like gasoline taxes. All of those things can be debated. They can be debated in the context of what it will do to our country's economy. But the sheer lunacy, the absolute sophomoric inanity of taking and saying we are going to abolish the Tax Code, I would suggest that you might as well, while you are at it, abolish the Criminal Code. That would give some Members of Congress, and particularly on the Republican side, relief from some fines and some jail terms. But other than that, why not abolish it and say, well, in the year 2002, we will write a new Criminal Code, but in the meantime, go do what you want. So as we are sitting here debating a bill that might at the outset make some reasonable sense to people who want to support private schools at the expense of destroying public education, a reasonable debate that has been going on for some time, we are getting prepared, as we sit here this morning, to bring to the House of Representatives a bill that would, in effect, end the Tax Code. I understand that there are a great number of modern-day Pharisees who reside here in the House of Representatives and other types of conservatives who believe that we should have no income tax. Again, the most sensible of those who purport to do that have a replacement. They would suggest a value-added tax or a sales tax or a whole host of revenue raising. But none have been so lunatic in their approach as to say we should raise no revenue. It would be interesting to talk to the members of our fighting forces. The gentlewoman from New York and I just returned from Bosnia where we were proud to see our forces keeping peace. They might want, as well, to throw up their hands and go home. How do they know that they will get paid at the end of the 3 years if the Republican mind-set were to continue to control this Congress? This is the most amateurish approach. It is pandering, pandering in the worst conceivable way for a few votes in an election year, pandering about something which some people does not understand. It is clear that whoever drafted and will support this legislation to sunset the Tax Code has no idea of what they are doing. They are not qualified. There are not many qualifications to membership in this body, but I will tell you one of them ought to be to be able to count to 20 with your shoes and socks on. I am not sure that many of my Republican colleagues could pass that test when it comes to the economics of dealing with the Tax Code. So as we sit here in all solemn splendor and discuss whether we are going to help our children, we are just waiting for an hour or two, and we will be in this Chamber saying, let us vote to sunset the Tax Code. Can you imagine what is happening in Jakarta which is a result of basically a king destroying the economic system in Indonesia? This is exactly what will happen in the United States if this Republican provision prevails. The financial markets will suddenly awaken and realize that none of the contracts, none of our pensions can be depended upon. The very basis of all of our retirement income will collapse. The stock market will be in shambles. I want to suggest to you that if you want to create financial anarchy in this country, follow the Republican lead. There is a Republican- mandated commission now that is talking about the future of Medicare, the future of Medicare. From where will the income come? From where will the taxes come? From where will the deductions come for the employers who are paying those taxes? This all disappears under this marvelous Republican leadership. What we are getting here is Dial-A-Prayer in the House of Representatives. Dial-A-Vote. Dial-A-Special-Interest. Dial-A-Special- Interest and ask them what they would like to hear the government do, and we will bring it to the floor of the House without regard to the effect on the United States, on its children, on its families. Family values? Let me ask the gentlewoman how she would expect any person in the United States could sell their home in the next 3 years, realizing that the homeowner's interest deduction will disappear in 2002. One of the mainstays of the American family is the right to buy and own a home. The value of homes will plummet as a result of this Republican-contrived cockamamy scheme to buy some attention from the right-wing wackos in this country who would say abolish the income Tax Code. So I say to my colleagues, while it may be of some interest to discuss, in all seriousness, how we can help our children get educated, we had better worry about whether our children will be able to sell apples on the street corner as children did in the bowels of the Depression, because with the Republicans in leadership, having no understanding of the basic tenets of economics, and leading this House in the most amateurish, asinine way, we will destroy this economy, destroy the values upon which the families are based, and lead us into a confused and distraught and archaic state in the United States. I urge my colleagues, please, to treat the upcoming tax sunset bill with all of the derision and scorn that it deserves. It is an amateurish bill, written and drafted by people who have not the foggiest concept of government, of how to govern, of economics, led by a leadership who is led around by the nose by extreme right-wing religious groups and right-wing wacko groups, and getting a vote a day on issues that some of their Members may have to run on in their districts. But I urge my colleagues to disdain any more of this foolishness in the House of Representatives. It brings discredit to this House. It brings discredit to those who would like, in all seriousness, to improve the lot of families, as the Democrats have been struggling to do. I urge my colleagues to vote ``no'' on the rule, vote ``no'' on this bill, and vote absolutely, absolutely ``no'' on the rule on the income tax sunset and, by all means, just vote ``no'' on sunsetting the income tax. Mr. Speaker, I thank the gentlewoman for yielding to me.

Mr. STARK

Mr. STARK. Mr. Speaker, as we seek to improve our health care system, it is important to include the concerns of all of our citizens-- especially those in less fortunate financial circumstances. A recent study in the Journal of the American Medical Association found that low-income citizens ``have a death rate as much as three times higher than that of other groups.'' The study found that, ``Americans with income below $10,000 a year had a death rate of 3.22 times that of people making $30,000 or more.'' Even after taking into account the riskier health behavior that is often attributed to the poor, ``the death rate among the poor was still 2.77 times higher.'' This clearly shows that many Americans are dying early simply because they are poor. A policy that results in the less fortunate dying for no other reason than their financial status cannot possibly be one that is working to the best interest of the American people. One thing we can do to improve this unfortunate situations is to provide better access to health care for the underprivileged. Tom Burke, a specialist in risk sciences at the Johns Hopkins School of Public Health, said: ``A big part of being poor is lack of access to medical care or perhaps not feeling culturally comfortable with the medical care providers, so things that are little health problems become bigger health problems, and you have people presenting themselves at a much more advanced state of disease.'' We can prevent many early deaths simply by treating health problems in the early stages. To do this we need to ensure that our health care system is accessible to all Americans irrespective of financial status. It is also important to remember that this situation carries far- reaching psychological implications. Children learn from their parents. And what will low-income children learn from their parents? They will learn, ``that the world is frightening and hostile place.'' Attitudes like these contribute to stress, poor choices, and early death. We cannot allow our health system to be ignorant of the needs of the economically disadvantaged.

Mr. STARK

Mr. STARK. Mr. Speaker, I thank the distinguished ranking member for yielding me this time. Mr. Speaker, the Republicans this morning are doing a rather silly exercise, I think. It is duplicitous, I guess, in its best light. They are trying to take out the user fees and revenue raisers for a separate vote, all except those which they have originated and left in. In other words, they are being selective. They will harm children, health care for the frail elderly, food for the poor. Their own user fees will pay for flood insurance and some homebuyers and air travelers, health insurance for civil servants. But not health insurance for people on Medicare, not health insurance for the poor, not health insurance for children. It is the same duplicitousness that we heard yesterday, the right- wing religious wackos who were talking about praying. Many of them made a claim to be Christians. What kind of a Christian would harm small children? What kind of a Christian would deny health care to the indigent? What kind of a Christian would deny housing to the poor? I do not know if that is ever mentioned. For the people on the Republican side whose plan is to destroy programs for the poor and to build their budget on the backs of the poor and then try to convince the American people they are Christians is a lie, it is duplicitous, and it is wrong. So as it is this morning, we are wasting our time and the public's time with political posturing for a bankrupt program. Why are we not spending the time this morning to talk about managed care reform? Why not the Norwood bill which 90 Republicans have joined which would give the American public what they want, and that is protection from the unscrupulous insurance companies who are making huge profits by denying managed care to the people paying for it? Where are the Republicans when it comes to protecting what 80 or 90 percent of the American people want? They are hiding. They are scared. They do not know what to do. They cannot organize to get the kinds of programs that we need. What about early buying at no cost to the government for those seniors who retire early and will be without Medicare or without health insurance? Why are the Republicans not bringing that part of the President's program to the floor so we can vote on it? Because they do not dare. Because they know that the American public wants programs that will win. Tobacco legislation; why are the Republicans burying tobacco legislation while we prattle about this silly bill which nobody wants? This is to distract the people from the fact that the Republican cuts in their own budget are so severe that program after program will be destroyed. The Speaker's desire to see Medicare wither on the vine is being helped by this plan to destroy all assistance to the people who, through no reason of their own, need assistance for a job, for housing, to feed their children. Those will be dismantled, as the Republicans would like to do. The Kasich budget does not provide the money to fight fraud and abuse. There is about $20 billion in improper payments under the Medicare program. Instead of providing us the funds to monitor that and save them money and cut those bills; 265 million is what it would take for the Medicare program to be able to save a good portion of that 20 billion; instead of cutting the error rate, we are cutting the budgets to the law enforcement people who could save that money. This Republican budget is pro-fraud. It is on the side of the criminals. That is who the Republicans are coddling with this. Quality will suffer. Nursing homes will go uninspected. So that those of us who are retiring and may want to go to New York or California and seek succor in a nursing home may find them dirty and poorly managed and of low quality because the Republicans are cutting the budget for the people who inspect those and ensure that our parents and our retiring colleagues who will need care in their senior years will not get it. The bills will be paid slower. Medicare beneficiaries will be unable to get questions answered about the new proposals the Republicans are sending out in the mail. So that as we see a small amount of money being denied as a way to obfuscate the bankruptcy of the Republican budget, the problems of this country increase, and the leadership on the Republican side continues to do nothing about it. Parliamentary Inquiry

Mr. STARK. Mr. Speaker, in the Republican budget, there are still $11 billion of user fees, flood insurance, homebuyers for FHA, air travelers, barge traffic on inland waterways, veterans seeking housing, health insurance for civil servants. Would the gentleman join with me to remove those user fees that are in the Republican budget? I would like to help him.

Mr. STARK. Mr. Speaker, I am sure that if any wacko in the House would like to raise to a point of personal privilege that the Speaker would be glad to recognize him for that purpose.

Mr. STARK. Mr. Speaker, will the gentleman yield?