Norman J. Ornstein

Paper prepared for Funding First/AAAS Workshop on "How to Fund Science: The Future of Medical Research," February 14-16, 1999, Wye River Conference Centers.

Few 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.

But 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?

One 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.

For 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.

In 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.

Just 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.

Breakthroughs 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.

But 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.

Those 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.

The 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.

The 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.

The 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.

The 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.

These 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.

But 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.

What 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.

Second, 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.

Analysis 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.

As 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.

As 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 post-impeachment coalition-building.

Now 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.

At 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 be harder.

There 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.

To 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.

But 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.

Create 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 tasks.

© 1999 American Association for the Advancement of Science