prepared for Funding First/AAAS Workshop on "How to Fund Science:
The Future of Medical Research," February 14-16, 1999, Wye River
areas match the potential to build broad bipartisan agreement of
medical research. Americans strongly support it. An overwhelming
share of major members of Congress, from fiscal hawks like John
McCain and Pete Domenici to liberals like Paul Wellstone and Henry
Waxman, have endorsed the plan to double the NIH budget, a plan
proposed in 1998's State of the Union message by President Clinton.
If lawmakers have their own pet projects or areas of research, nearly
all believe both that research in general is valuable to the society
and an appropriate venue for the involvement of the federal government.
while funding has increased significantly in the past few years,
the money has not come close to matching the mouths of the members-and
is not likely to in the foreseeable future. Why would something
that the American public and its politicians both enthusiastically
support not be fully funded?
reason, of course, is budgetary. It turns out that the politics
of surpluses, if different from the politics of deficits, is no
easier or simpler. The advent of pay-as-you-go rules in the 1990
budget agreement has reinforced the fact that, whether deficits
or surpluses are the rule of the day, discretionary budgets are
tight and basically operate in zero-sum circumstances. At the same
time, the continuing growth of entitlement programs like Social
Security and Medicare has squeezed discretionary budget items in
the context of the overall budget numbers.
medical research, this has meant a triple bind. It must compete
with other discretionary domestic programs, like Headstart or education,
for a share of the discretionary domestic pie (which in turn is
affected by the defense budget number.) It must cope with the reality
that the entitlement juggernaut continues to grow in ways that crowd
out all discretionary spending growth. And, to some degree, medical
research must compete with other areas of research and development,
in non-defense science and defense, among others. And, of course,
there is additional competition within the medical research budget,
affected in part by the "disease-of-the-month" phenomenon, including
the relative effectiveness of outside lobbies on AIDS, breast cancer
and other areas at reaching the public and members of Congress.
this context, the only hope for a sizable increase in a discretionary
line-item is to find a new and unassailable source of revenue for
it. The Clinton plan to double the NIH budget was contingent on
the huge revenue windfall from a tobacco settlement. When no tobacco
settlement was forthcoming, no budget multiplier was possible. Theoretically,
to be sure, the huge projected revenues from budget surpluses could
be used for a cornucopia of social program needs and demands. The
president's 1999 State of the Union message did include such a cornucopia,
but with the emphasis on the political sizzle of a lot of small
initiatives rather than on the steak of sizable increases in a few
key areas. Moreover, a deconstruction of the president's speech
does not provide much hope for medical research advocates. The president
mentioned breakthroughs in treatments for areas like Parkinson's
disease, but did not mention NIH funding. He did mention the need
to increase funding in high-tech computing research, giving it some
primacy in the competition for research funds generally.
as significantly, the bulk of the surplus revenues got waylaid by
the larger entitlement problems and the political dynamic of the
defense budget. When the president's budget earmarked roughly 85
percent of future surpluses for Social Security, Medicare and defense,
other social programs got squeezed from any windfalls. If the budget
were the only obstacle, long-term prospects for long-term funding
would still be quite bright. Science is doing well in many ways
on Capitol Hill, especially on the medical side. There is no sign
of the hostile attitude and active investigations of fraud or chicanery
that were apparent on Capitol Hill in the eighties, typified by
the House Commerce Committee investigation into David Baltimore
and his colleagues. NIH leaders, including Harold Varmus, are widely
respected on Capitol Hill.
in treatments for diseases like AIDS, Parkinsons, Alzheimers and
cancer are noted and appreciated by the public and by its representatives,
and help improve the climate for more research generally. There
is a widespread understanding that medical research provides a substantial
bang for the buck. In the context of a 1.7 trillion dollar budget,
the amounts of money involved here, perhaps 1-1/2 percent of the
budget, are small. Eventually, those factors should combine to provide
major increases in funding.
even if more funding is forthcoming, the continued squeeze on discretionary
spending, along with other political dynamics, means that funding
will likely come with more, rather than fewer, strings. Whether
liberal or conservative, Democrat or Republican, members of Congress
will be reluctant to give their dwindling number of discretionary
dollars without direction or condition. One aspect of that will
be the continuing earmarking of portions of the budget for specific
areas of research. More broadly, in a highly explosive, politicized
atmosphere, it will be hard to insulate medical research from the
elements of that politics, whether they involve embryo research,
sex, or other elements that involve partisan or ideological competition.
kinds of challenges will accompany any substantial increase in funding.
But there are other factors, substantive and political, that make
the task of finding significant long-term funding a daunting one.
In this paper, I will address some of them.
106th Congress. For anyone looking to the 106th Congress for
policy-making, the challenges are formidable. This Congress starts
out characterized by small partisan majorities, sharp ideological
polarization, weak leadership, a short attention span and an attenuated
schedule. Those problems have been exacerbated by the bitter partisan
divisions and harsh feelings generated by the House impeachment,
on almost purely partisan lines, of the president and the difficulty
of the Senate to extract itself smoothly from the impeachment thicket.
That description demands some explanation. Start with a broader
point. The 1998 election had a strikingly small number of truly
contested seats-probably no more than 35 or so in the House, or
a third to a half of a typical congressional election. 94 seats
were wholly uncontested. 1998 reinforced a pattern building over
two decades, of more and more seats becoming increasingly safe.
Safe seats has meant lawmakers more sensitive to their party primaries
than to competition in general elections. With primaries usually
dominated by each party's ideological base, that has meant more
members representing their bases, and more members bending over
backwards to accommodate those bases.
typical post-World War II Congress was characterized by a classic
"normal distribution" in ideological terms. Most members could be
characterized as in the broad center of the political spectrum.
To use a football field analogy, most lawmakers would have been
clustered near the midfield stripe, between the thirty-five or forty
yard lines. The centrist tendencies in both parties fit well most
of the senior members, meaning that on many committees, a shift
in majority would have led to a shift in chairmanships that would
result in little if any ideological change. For example, a move
in the 1960s from Wilbur Mills (D-AR) as Chairman of Ways and Means
to John Byrnes (R-WI) would have had no discernable policy consequences.
But in the typical post-WWII Congress, few would have spent time
thinking about a shift in majority-it didn't happen for forty years,
and rarely came within striking distance of happening.
current Congress has a classic bimodal distribution. Perhaps fifteen
percent or so of the members are near the midfield line. There are
substantial numbers of lawmakers around each ten-yard line-and lots
of members behind each goal post! The ideological differences are
most distinct among senior members and leaders-contrast current
Ways and Means Chairman Bill Archer (R-TX) with current ranking
member Charles Rangel, for example. The same is true of party leaders-look
at the gulf between a Tom DeLay and a David Bonior. And in the current
era, these dramatic differences matter even more because the majority
in Congress is clearly up for grabs-has been in the past three elections,
and likely will be for the foreseeable future. So the stakes, in
terms of outlook, agenda-setting, staff and power, are enormous.
change is more than ideological. Approximately two-thirds of the
members of the current House have been elected since the 1990s began.
This is a post-Cold War Congress, with many fewer military veterans,
largely unconcerned with the world around it, and a Congress reflecting
the basic attitudes of the Nineties, including a disdain for institutions
and leaders generally. For any leader, an essential need for strong
leadership is... followership. And few of the newer members are
natural instititutionalists or followers.
general characteristics have been amplified for the current Congress
by specific conditions. Every Congress is shaped by a bookend pair
of elections-the one that brought it in, and the one Congress faces
when it leaves two years hence. By that measure, the 106th Congress
is a distinctive and unusual one. The 1998 election, on the surface,
was a boring one-characterized by the smallest change in partisan
terms in modern memory. There was a five-seat net shift in the 435-member
House, along with no net change in the Senate and a one seat net
change in governorships-a classic endorsement of the status quo.
the lack of partisan change is highly deceptive, and the adherence
to the status quo misleading. In this case, as my colleague Tom
Mann has said, the motto might be, "Plus c'est la meme chose, plus
ca change," (the more things stay the same, the more they change.)
1998 was a midterm election; in only one such contest since the
Civil War (1934) has the president's party actually gained seats
in the House of Representatives. It was also the second midterm
of a two-term president; typically, in such a sixth-year contest,
the president's party loses large numbers of seats in both the House
and Senate. Republican expectations in September and early October
were for very healthy gains in both chambers. The results, of course,
were far different. Democrats broke the historical pattern, gaining
five seats, and dodged a bullet in the Senate, going from a projected
loss of four or five seats to no net change.
happened between the GOP optimism in September and the huge disappointment
in November? First, Republicans badly misjudged public opinion on
Bill Clinton and impeachment. From their rush to release the bulk
of Ken Starr's 60,000 page referral by the end of September to gain
maximum advantage in the campaign, to their subsequent premature
release of the President's videotaped Grand Jury testimony, the
Republican congressional leaders' efforts to use impeachment to
energize their conservative base while demoralizing that of the
Democrats backfired. It was Democrats who became energized, motivated
by their distaste for Clinton's political adversaries.
Republicans botched the only "must-pass" bit of legislative business,
failing to enact any of the 13 appropriations bills by the beginning
of the fiscal year. They thus precipitated a broad confrontation
with the White House, evoking the specter of a shutdown of the federal
government which they could not win, and leaving the appropriations
process dragging on into mid-October. Republicans were left with
the worst of all possible political worlds. They looked dilatory
and obdurate to the voters. At the same time, they enraged their
base by giving in, out of political necessity, to the bulk of the
president's demands on individual appropriations items. The promise,
to their base, that caving to the president would pay off, because
the party would gain enough seats to thwart the president in 1999,
was an empty one.
of the election day exit polls showed some clear patterns. 1998
was, more than anything else, a referendum on the U.S. economy at
a time when an astonishing 78 percent of Americans were happy about
it. Not surprisingly, the result was an overwhelming endorsement
of incumbents (98.3 percent winning reelection in the House, and
over 90 percent in the Senate.) More surprisingly, it was Democrats
who got rewarded for the good economic times; the more voters were
happy and optimistic about the economy and their own role in it,
the more they voted Democratic. Republicans, whose performance as
the congressional majority merited some considerable share of the
credit for the strong economy, got little recognition. The Republicans
managed to snatch defeat from the jaws of victory.
a result, Democrats were exultant and Republicans frustrated. The
immediate upshot was a series of challenges to House and Senate
leaders, with the most prominent casualty being the Speaker of the
House, Newt Gingrich. But there were other consequences. Weakened
Republican leaders could not, after the debacle with appropriations,
draw back from the impeachment process without a revolution from
the right; thus, an election that rebuffed GOP efforts to impeach
the president actually enhanced the chances for impeachment to succeed
in the House. And, of course, as impeachment proceeded in the House,
it claimed as its first casualty Speaker-designate Robert Livingston.
Replacement Dennis Hastert, while widely respected for his legislative
acumen, was seen by Democrats as a lieutenant of Tom DeLay, and
did not bring the kind of reputation for depth and formidability
that had been held by Gingrich and Livingston.
I write this, the impeachment process continues on in the Senate.
Senate Republicans have been unable to meet their goal of ending
it early in a bipartisan way. If many have disdain for the House
Republican managers and the way they handled impeachment in the
House and in the Senate, they see their own fate yoked to their
House brethren, and fear the political consequences among the party
faithful if they short-circuit the process. Whenever and however
the impeachment dynamic ends, it will likely lead to a searing and
soul-searching debate within GOP ranks, one that is unlikely to
leave Senate leaders stronger than when they began the Congress.
And if the poisonous partisanship in the House did not entirely
spill over into the Senate, it did leave a significant residue for
consider the other bookend, the upcoming 2000 election. Had Republicans
in 1998 won, say, twenty seats in the House and four in the Senate,
their margins would have been great enough to leave them confident,
barring a cataclysm, of holding both chambers in 2000. But the actual
results left them with a miniscule majority in the House, the smallest
in 44 years, and with a vulnerable margin in the Senate. In 2000,
19 of the 33 Senate seats up for contest are held by Republicans,
with many considered vulnerable. Most of the Democrats' 13 seats
up for contest-seats they managed to win in the disastrous election
in 1994-are safer at the start.
the same time, 2000 will bring the first open contest for the presidency,
with no incumbent running, since 1988. Open contests are almost
always more competitive than elections with an incumbent running.
The stakes are thus higher, and both parties will face contested
nominations through primaries and caucuses. For the first time in
most of our adult lifetimes, the White House, House and Senate are
all genuinely up for grabs. This has several implications. Parties
will be even more anxious than usual to define issue and policy
differences with the other side, and to factor electoral politics
into policy decisions. Building bipartisan coalitions will thus
will be many presidential candidates, especially on the non-incumbent
Republican party side, several will come from Congress, they will
be highly visible early on in the cycle, and their rhetoric will
become more ideological to accommodate the primary activist base.
The focus on campaigning as opposed to governing will start earlier,
and the desire by lawmakers to adjourn and campaign will be greater
than usual. Sharp partisan divisions, high partisan stakes, and
low attention spans are not conducive to good policy-making. But
not all is bleak. Republicans in Congress, anxious to retain their
majorities, will be eager to make a record of policy accomplishment
to overcome the harshly negative image they received from the impeachment
process. President Clinton will be eager to make his own record
of accomplishment to obviate the impact of the House impeachment.
be sure, congressional Democrats will have much less desire to ring
up bipartisan policy victories. But the same motives were apparent
in 1996. Then, some issues, like increasing the minimum wage, were
framed by the president in ways that pushed reluctant Republicans
to support them while Democrats eagerly agreed; other issues, like
welfare reform, were framed in ways that pleased Republicans but
left many Democrats unwilling to oppose reform. If there is anything
resembling a soft landing in the Senate from the impeachment imbroglio,
the same dynamic could play out in 1999-2000, leaving room for broad
bipartisan support for slam-dunk issues like medical research.
an issue cannot be a slam-dunk unless its proponents can get close
enough to the basket to put the ball through. That means getting
medical research on the agenda, separated enough from other budget
categories that it can be considered on its own merits. That will
not be easy in post-impeachment Washington. An opportunity may exist
if and when Congress and the president engage in a great debate
over the future of Medicare. The chances of bipartisan compromise
are enhanced by the central role of Senator John Breaux (D-LA,)
who is respected by most senators and admired by the president.
Nonetheless, it is clear that any compromise on Medicare will be
difficult to find, in part because of the substantive difficulty
of finding long-term solutions. But in a focused national debate
on the future of Medicare, the role of research in reducing society's
health costs for debilitating illnesses among seniors can be highlighted,
turning the congressional focus more directly to research.
the focus, and the climate for more research funding will be enhanced.
But make no mistake about it-the ability to do so, and to achieve
both assurances of more funding and more flexibility to engage in
the widest range of research activities, remain difficult and daunting
1999 American Association for the Advancement of Science