Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, the U.S. is No. 1. But that's nothing to cheer about when you're the No. 1 exporter of tobacco products. According to the World Health Organization [WHO], the U.S. is the top exporter of tobacco products world wide, yet tobacco products represent less than 1 percent of total U.S. export earnings. Two recent studies by the National Bureau of Economic Research [NBER] and WHO have pointed out some disturbing information about the U.S. role in promoting tobacco products around the world and our international support of this addictive drug. Since tobacco consumption has decreased by as much as 20 percent in the last 20 years in the U.S. and other highly industrialized nations, tobacco companies have been forced to turn elsewhere to shore up their huge profits. That elsewhere is foreign markets like Taiwan, Thailand, Japan, and South Korea. Since the early 1980's, the tobacco industry has been aggressively pressuring countries to open their markets to American tobacco products--and using U.S. trade policy to do it. Spurred by the tobacco industry, the U.S. Trade Representative [USTR] and the Commerce Department have successfully persuaded Asian countries to open their heavily restricted cigarette markets to U.S. tobacco products or face retaliatory measures. The tobacco industry has been extremely successful in their conquest of the world tobacco market. The NBER study found that in 1991, U.S. tobacco market share in four Asian countries that lifted their import curbs was up 600 percent. Since 1975, U.S. cigarette exports have increased by 340 percent, up from 50.2 billion cigarettes in 1975 to 220.2 billion cigarettes in 1994. But at what expenses to world health? According to the NBER report, the per capita cigarette consumption in Asian countries is almost 10 percent higher than it would have been if markets weren't open to American cigarettes. In their recent study of world tobacco and health trends, WHO found that, in the early 1990's tobacco products caused an estimated 3 million deaths world wide per year. In addition, WHO documents that at least one person dies every 10 seconds as a result of tobacco use around the world. Don't we have other American products to promote through the U.S. trade Representative? Why are we promoting products that unequivocally kill people when used as intended? The United States has an abundance of other products that the USTR could be promoting. Is opening markets for cancer-causing tobacco products the best allocation of USTR resources? From smoke-free workplaces to the proposed FDA regulation of tobacco, as the United States continues to enact stricter controls regarding tobacco use, we should set a positive example to the rest of the world by promoting healthy, tobacco-free lifestyles. How can we continue to strive to reduce tobacco use at home, but continue to promote tobacco use abroad? The U.S. is known as the leader of the free world. We should lead the fight against tobacco use, rather than lead the world in tobacco sales.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to congratulate Mr. Victor Bacelis on the receipt of the Jefferson Public Service Award, which he received on Wednesday, June 19, 1996. The Jefferson Award was founded in 1972 by Jacqueline Kennedy Onassis and Senator Robert Taft, Jr., and is presented each year by the American Institute for Public Service as part of a celebration of service to America. Mr. Bacelis is a model constituent who received this award as the result of a selfless act which helped a fellow Californian. Victor's native Mexican village in the Yucatan Peninsula was so poor there were no schools. His family never had much in the way of material luxuries, but was rich in the values of hard work, generosity, and kindness. He was working between 96 and 100 hours a week at three different jobs to support himself and those he cared about. He was mopping the floor in a Fremont McDonalds when he found $600 on the floor. Most people would have kept it and told no one. After all, it was cash, and certainly would have tempted even the most honest person. But Victor did as the law instructed; he reported it. The money remained unclaimed. Victor then made a decision that very few people would make. Even though he was saving to buy a house, he gave the money to charity. A local family had recently made a public plea for help. Adrian Sandoval, a 22-month-old boy, needed a bone marrow transplant, and his parents could not afford the procedure. Victor was touched by the story of this family, which had already lost one young child to the same rare genetic disease. Mr. Bacelis contributed the cash he had discovered and in doing so, saved a young and innocent life. He says, and I quote, ``I couldn't accept what was happening at the time. I would have traded places with that baby, but that's impossible and I had to be a realist and take another form of action. * * * It was not my intention to be recognized as a `hero,' I just wanted to help. It's part of my obligation as a human to help others.'' His involvement in the Sandovals' lives did not end with the $600 contribution. He makes an effort to support transplant patients by recruiting potential bone marrow donors for other children. He volunteers his time to the San Francisco-based Latino Marrow Donor Program. And even as public recognition of his efforts grows, he continues to decline any personal gain. He has been offered money awards, a full scholarship and housing at Stanford University, and even a job with the San Francisco 49'ers, but none of these offers interested him. Instead, he wants everyone who finds value in his actions to become registered donors. Mr. Speaker, Victor Bacelis has found a cause in which he believes. Through a simple twist of fate, he has taken the opportunity to touch the lives of others more needy than himself. His story restores and reinforces faith in the integrity of the American people. Mr. Speaker, I ask that you and my colleagues join me in recognizing Victor Bacelis for his magnanimous contribution to the lives of transplant patients. I wish him much success in all his future endeavors.

Mr. STARK

Mr. STARK. Mr. Speaker, once again, Professor Uwe Reinhardt, cuts to the heart of the matter with his June 19, 1996, essay in the Journal of the American Medical Association entitled ``Economics.'' His short article is reprinted below. It is blunt. Americans have decided to ration health care by income class. The poor will die earlier than the rich. The poor will suffer more. Their children will be doomed to less healthy lives. That's the truth. We try to hide from that truth behind ideologies and high-flown talk of ``market-based'' health care systems. We pretend to be a Christian nation, but we violate all of Christ's teachings in our health care system, and hide our hypocrisy behind economic jargon about efficiency and competition and free markets. For a conscience-challenging essay, read on: Economics (By Uwe E. Reinhardt, Ph.D., Princeton University) Breakthroughs in the sciences often take the form of replacing 1 hitherto held hypothesis with another. In the social sciences, that process tends to be controversial, because hypotheses usually can be tested only on crude, nonexperimental data that tend to be compatible with numerous rival hypotheses (theories). More often than not, the individual social scientist's allegiance to this or that theory is dictated by that individual's personal predilections.\1\ A ``breakthrough'' in the social sciences, therefore, may be nothing more than the triumph of 1 ideology over another. --------------------------------------------------------------------------- Footnotes at end of article. --------------------------------------------------------------------------- During the past decade or so, economics experienced such a breakthrough. Certain theories favored by large segments of the profession, the ideology they embodied, and the felicitious jargon they inspired came to dominate the thrust of American health care policy. Goaded in good part by the writings, teaching, and punditry of economists, American politicians increasingly treated health care as just another private consumer good--certainly no different from food, clothes, and shelter--and physicians and hospitals as mere purveyors of that good. Hand in hand with that notion came the proposition that a free market can produce and distribute health care more ``efficiently'' than can any other imaginable arrangement. Hand in hand with that proposition, in turn, came the social ethic that the quantity and quality of health care received by individuals can properly vary with their ability to pay for that care. It is imperative to hedge this assertion at the outset. First, by no means all American economists subscribe to this distributive ethic for health care. Second, by no means all American economists play politics thus in the guide of science. Many of them scrupulously apply scientific methods to identify the trade-offs that require moral choice on the part of policy-makers without packaging their own moral values into their analyses. Scrupulous economists are mindful that the term ``efficiency'' has a quite technical meaning that severely limits its proper use in practical applications.2,3 Every freshman in economics, for example, is or ought to be taught that the more efficient of 2 alternative policies is not necessarily more preferred, unless both policies achieve exactly the same outcome. To illustrate, a cost-minimizing (efficient) policy that succeeds in immunizing only, say, 80% of a target population is not necessarily superior to a more wasteful (inefficient) policy that succeeds in immunizing the entire population. Similarly, one cannot meaningfully compare 2 nation's health care systems in terms of their relative efficiency, if these 2 nations pursue different standards of equity across socioeconomic classes. Srupulous economists know that virtually all benefit-cost analyses performed by economists are highly suspect if the benefits and costs in question do not accrue to the same persons.\4\ The explanation is simple: If we measure benefits and costs in dollars, then a dollar of benefit (or cost) accruing to a poor person represents a quite different intensity of pleasure (or pain) than a dollar of benefit or cost accruing to a rich person. Following a dogma first proposed by the British economist Nicholas Kaldor,\5\ economists have tried to escape this conundrum with the tenet that, if those who benefit from a social policy gain enough to be able to bribe the losers into accepting that policy, then that policy enhances social welfare even if the bribe never is paid. It is a preposterous sleight of hand.\4\ Yet without it, many benefit-cost analyses sold by economists lose their legitimacy. Economists ought to protest loudly the canard repeated with such distressing frequency during the health system reform debate of 1993 and 1994 that only a ``market approach'' to health care can avoid ``rationing.'' \6\ Every freshman knows that markets are just 1 of many methods of rationing goods and services. Markets do it by price and ability to pay.\7\ Finally, properly trained economists know that when person A derives satisfaction from knowing that individual B consumes a particular commodity (which tends to be true for much of health care), then the prices generated in free markets systematically underestimate the social value of such commodities.8,9 That important insight is forgotten by economists who model health care simply as just another private consumption good \10\ and who would blithely and quite illegitimately impute to, say, a physician visit by a baby from a low-income family a social value equal to the maximum price the baby's parents would be willing (and able) to pay for that visit. In short, properly trained and scrupulously practicing economists appreciate that their ability to offer normative pronouncement on health policy is much more limited than seems widely supposed among policymakers. Normative economics seeks to prescribe what ``ought'' to be done. Because public health policy almost always redistributes economic privilege among members of society, such prescriptions almost always involve moral judgments best left to then political arena. Economists are at their professional best when they offer purely positive, value-free analysis--for example, when they estimate empirically the responses of physicians, in terms of patients seen or hours worked, to ceilings on their fees or to increases in their malpractice premiums. Economists can also produce useful positive analyses by using their empirical estimates to simulate likely responses to proposed policies--for example, the imposition of a mandate on employers to provide their employees with health insurance.\11\ Alas, even here ideology may creep in. During the health system reform debate of 1993 and 1994, for example, the opponents of such a mandate had no trouble finding respected economists who imputed to that mandate large losses in employment. These economists assumed that, over time, the cost of the mandate would be passed to employees through lower take-home pay, and that the supply of labor is highly sensitive to changes in take-home pay. On the other hand, policymakers who favored the employer mandate had no trouble finding equally respectable economists who assumed the supply of labor to be rather insensitive to take-home pay, in which case the mandate would lead to only a modest reduction in employment.\12\ As Victor Fuchs \13\ has argued, the school of scrupulous economists did not carry the day during the health system reform debate of 1993 and 1994. That debate may have come across to the media and the laity as merely a giant exercise in accounting. In fact, it was the culmination of a decades- old battle over the proper distributive ethic for American health care. The issue can be crystalized in the following pointed question: To the extent that our health system can make it possible, should the child of, say, a waitress or a gas station attendant have the same chance of avoiding a given illness and, if afflicted by it, of surviving and fully recuperating from it as, say, the child of a corporate executive? Evidently, the dominant decision makers in this nation have now concluded that our health system can properly offer the executive's child a higher probability of avoiding illness, or of surviving and fully recovering from a given illness, than it offers the child of a gas station attendant or waitress--that our health system can properly be tiered by income class. That is purely a moral judgment. As such, it is not wrong. But it would have been appropriate, in a democracy, to debate this important question more explicitly than it was. Instead, the proponents of this distributional ethic cloaked their case in the jargon and normative theories willingly supplied, without proper warnings, by the economics profession. Thus, the new ethic was sold to the public by the argument that a ``market-based'' health system in which individuals are granted ``responsibility'' for their own health care (and their own health status!), and in which individual ``consumers'' are ``empowered'' to exercise ``free choice'' of the ``consumer good'' health care, would be more ``efficient'' (and hence ``better'') than any alternative system, and that it would obviate the need for ``rationing'' health care. But to tell an uninsured single mother of several possibly sickly children that she is henceforth empowered to exercise free choice in health care with her meager budget is not necessarily a form of liberation, nor is it efficient in any meaningful sense of that term. It is rationing by income class. To have one's professional jargon, hypotheses, and embedded ideology dominate in this way may be a triumph of sorts. Readers will judge whether it was a genuine accomplishment. footnotes \1\ Nelson R. The Moon and the Ghetto. New York, NY: WW Norton & Co Inc; 1977: lt 23. \2\ Bator FM. The simple economics of welfare maximization. Am Econ Rev. 1958; 72:351-379. \3\ Reinhardt UE. Reflections on the meaning of efficiency: can efficiency be separated from equity? Yale Law Policy Rev. 1992;10:302-315. \4\ Baumol WJ. Economic Theory and Operations Analysis. 4th ed. Englewood Cliffs, NJ: Prentice-Hall International Inc; 1977:chap 21. \5\ Kaldor N. Welfare propositions of economists and interpersonal comparisons of utility Econ J. September 1939:549-552. \6\ Reinhardt UE. Rationing in health care: what it is, and what it is not. In: Altman EH, Reinhardt UE, eds. Strategic Choices for a Changing Health System. Chicago, Ill: Health Administration Press; 1996. \7\ Rosen HS, Katz ML. Microeconomics. Homewood, Ill: Richard D Irwin Inc; 1991:15-16. \8\ Kearl JR. Principles of Microeconomics. Lexington, Mass: DC Heath & Co; 1993:chap 16, especially p 418. \9\ Friendman LS. Microeconomic Policy Analysis. New York, NY: McGraw-Hill International Book Co; 1984:64-70. \10\ Phelps CE. Health Economics. New York, NY: Harper Collins Publishers Inc; 1992:chap 4. \11\ Clinton W. President Clinton's Health Care Reform Proposal and Health Security Act, as Presented to Congress on October 27, 1993. Chicago, Ill: Commerce Clearing House Inc; 1993. \12\ Krueger AB, Reinhardt UE. The economics of employer versus individual mandates. Health Aff (Millwood). Spring 1994:34-53. \13\ Fuchs VR. Economics, values and health care reform. An Econ Rev. 1996;86:1-24.

Mr. STARK

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

Mr. STARK. Mr. Speaker, I yield 3 minutes to the gentleman from Michigan [Mr. Bonior].

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from Ohio [Mr. Brown].

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from Oregon [Mr. DeFazio].

Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished gentleman from Virginia [Mr. Wolf].

Mr. STARK. Mr. Speaker, I am happy to yield 1 minute to the gentleman from South Carolina [Mr. Spratt].

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from Massachusetts [Mr. Markey].

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentlewoman from Georgia [Ms. McKinney].

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentlewoman from Ohio [Ms. Kaptur].

Mr. STARK. Mr. Speaker, I would just like to remind my colleagues that China never was willing to deal with intellectual property rights until they were faced with the threat of trade sanctions. At this point I am delighted to yield 11 minutes to the gentlewoman from California [Ms. Pelosi] who has been a leader in fighting for open trade, for human rights, and for bringing China into the world of nations of human beings.

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from New Jersey [Mr. Menendez]. (Mr. MENENDEZ asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I reserve the balance of my time.

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentlewoman from Connecticut [Ms. DeLauro].

Mr. STARK. Mr. Speaker, I yield the balance of my time to the gentlewoman from California [Ms. Pelosi] who has worked so hard for human rights and open trade throughout the world.

Mr. STARK. Mr. Speaker, the gentlewoman from California has touched on a lot of issues that are important to our colleagues: trade, jobs in this country, intellectual property. She somehow has missed a point or two that I am concerned with, and if I voted against this resolution, would I not, in effect, be supporting the thousands of children that have died in China's orphanages, where girl orphans have been selected for dying rooms, where they are tied up and left to die from neglect and starvation after they have been sexually assaulted? If I voted against this resolution, would I not really be voting to support the practice of taking prisoners and executing them and selling their organs to the highest bidder, which goes on in China today? And would I not be supporting, if I oppose this amendment, the fact that religious freedom does not exist and that harsh crackdowns of any unofficial religion, which is all religions except the State, the religious leaders are subject to physical abuse and prison terms? Would that not be the effect of my voting against this resolution?

Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Massachusetts [Mr. Kennedy].

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from Connecticut [Mr. Gejdenson].

Mr. STARK

Mr. STARK. Mr. Speaker, each year the President must seek a waiver from Congress to allow China to have most-favored-nation [MFN] status. Each year, China gives me at least one new reason to oppose normalized trade with China. China consistently and flagrantly violates our laws and repudiates our values. China was caught red-handed sending materials to create nuclear weapons--last year to Iran and this year to Pakistan. World peace threatened, just to make a buck. China's human rights violations have been a longstanding problem. Who among us could forget the sight of those tanks crushing students whose only crime was to meet publicly and peacefully to voice their opposition to their government? China still refuses its citizens the right to speak freely and to meet publicly. This year's transgressions implicate China's top government officials. A series of Chinese companies operated by the children of senior Chinese officials played a major role in the illicit copying of over $2 billion of United States commercial goods. Even worse, the son-in-law of China's top leader, Deng Shau Xiaoping, along with other relatives of top Chinese Government officials, has been implicated in the biggest seizure of illegal guns in our Nation's history. As you know, on May 22, 1996, U.S. customs officials intercepted $4 million worth of illegal AK-47 automatic weapons. The link between this illegal shipment and the Chinese Government is direct and indisputable. I wrote the President urging him to bar all trade in the United States with the companies involved in this outrageous gun running scheme. The problem is not just the companies but to the government of China which exhibits a pattern of flaunting of United States and international laws. The Chinese Government has no regard for the safety of our streets and our children, or the safety of our world. For these reasons, I adamantly oppose granting China favorable trading status. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Maryland [Mr. Cardin].

Mr. STARK. Mr. Speaker, I ask unanimous consent to yield 30 minutes of my time to the gentleman from Kentucky [Mr. Bunning] and that he be permitted to control that time.

Mr. STARK

Mr. STARK. Mr. Speaker, I know it is not fashionable to seek perks for Members of Congress, but we desperately, desperately need one--and the country would be better for it if we obtained this benefit for ourselves. We need the mental health parity amendment, because a majority of the Members are clearly suffering from severe mental disconnect, and as an institution, we are in need of treatment. I refer, of course, to the insanity of spending long hours trying to pass the Kennedy-Kassebaum amendment to improve health insurance coverage, while we are also about to pass Medicaid budget cuts which will effectively remove health insurance coverage from millions of Americans. The Congressional Budget Office estimates that Kennedy-Kassebaum bill might help about 550,000 people a year when they switch jobs or leave a job which offers health insurance and want to buy a policy of their own. It is a nice little bill and justifiably helps many worthy people. The Medicaid budget bill, on the other hand, will probably reduce Medicaid resources by a quarter of a trillion dollars over the next 6 years, and remove the guarantee of adequate health insurance from millions of children, parents, and grandparents. Thirty-seven million low-income blind, disabled, aged, and low-income children and their families are currently covered by Medicaid. Far more people will be hurt by the Medicaid cuts than will ever be helped by the Kennedy- Kassebaum bill. If an individual pursued two such diametrically opposed actions, we'd say he was unbalanced and should seek professional help. The Senate in Kennedy-Kassebaum adopted an amendment to provide basically equal coverage of mental and physical health. I understand that that provision is being dropped. It is unfortunate. Members of Congress could use help.

Mr. STARK

Mr. STARK. Mr. Speaker, I know it is not fashionable to seek perks for Members of Congress, but we desperately, desperately need one--and the country would be better for it if we obtained this benefit for ourselves. We need the mental health parity amendment, because a majority of the Members are clearly suffering from severe mental disconnect. As an institution, we are in need of treatment. I refer, of course, to the insanity of spending long hours trying to pass the Kennedy-Kassebaum amendment to improve health insurance coverage, while we are also about to pass Medicaid budget cuts which will effectively remove health insurance coverage from millions of Americans. The Congressional Budget Office estimates that the Kennedy-Kassebaum bill might help about 550,000 people a year when they switch jobs or leave a job which offers health insurance and want to buy a policy of their own. It is a nice little bill and justifiably helps many worthy people. The Medicaid budget bill, on the other hand, will probably reduce Medicaid resources by a quarter of a trillion dollars over the next 6 years, and remove the guarantee of adequate health insurance from millions of children, parents, and grandparents. Thirty-seven million low-income blind, disabled, aged, and low-income children and their families are currently covered by Medicaid. Far more people will be hurt by the Medicaid cuts than will ever be helped by the Kennedy- Kassebaum bill. If an individual pursued two such diametrically opposed actions, we'd say he was unbalanced and should seek professional help. The Senate in Kassebaum-Kennedy adopted an amendment to provide basically equal coverage of mental and physical health. I understand that that provision is being dropped. That is unfortunate. Members of Congress could use the help.

Mr. STARK

Mr. STARK. How much time do I have remaining, Mr. Chairman?