Congressional Record, Volume 143 Issue 118 (Tuesday, September 9, 1997)

[Congressional Record Volume 143, Number 118 (Tuesday, September 9, 1997)]
[Senate]
[Pages S8958-S8971]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS ACT, 1998

The Senate continued with the consideration of the bill.
Mr. SPECTER. Mr. President, under a previous agreement, the
distinguished Senator from Arizona, Senator McCain, will proceed with
his amendment for 1 hour.
I have discussed the amendment offered by the distinguished Senator
from Washington, Senator Gorton. He has two amendments pending. Let me
be sure which of the amendments we have here. It is an amendment
denominated to allow States to use funds under the Social Security Act
to provide health insurance coverage for children with incomes above
the minimum Medicaid eligibility requirements.
Senator Gorton advised me he would be agreeable to a time agreement
of 1 hour equally divided. He is not now on the floor, but he made that
representation to me. I do not, frankly, like to proceed without having
him on the floor, but I ask unanimous consent that we may proceed--
well, I am advised there may be a question on the other side of the
aisle.
But let me proceed, Mr. President, to say that if we are able to lock
in that time agreement, then the managers would like to proceed to the
two debates, 1 hour each, which would bring us to 4:40, at which time
we would have two votes stacked back to back.
At the conclusion of those votes, or after the first vote, when the
Senators are present, it would be my intention, as manager of the bill,
to try to seek time agreements on the outstanding amendments which are
pending at that time. The Senators will all be on the floor after the
first vote and before the second vote.
We are within striking distance of seeing some light at the end of
the tunnel. If we could have Senators on the floor at that time, I
think we could come to closure. We have the amendment by the
distinguished Senator from Illinois, Senator Durbin, pending on the tax
issue. It is my hope that we can get a 1-hour time agreement on that,
equally divided. I know that is agreeable to Senator Durbin, but there
are others who may offer a second-degree amendment, Senator Ford
perhaps, and others who are not now present. If we could get that
resolved after the first vote, it would be helpful on the management of
the bill.

[[Page S8959]]

Mr. DASCHLE addressed the Chair.
The PRESIDING OFFICER. The distinguished Democratic leader.
Mr. DASCHLE. Reserving the right to object, I think the suggestion
made by the distinguished Senator is a good one. I intend to support
it. I ask, if we can add to that, a unanimous consent request that
Senator Durbin be recognized to offer his amendment, leaving open the
option of people offering second-degrees following the two votes that
you suggest.
Mr. SPECTER. Mr. President, if my distinguished colleague will yield,
I would be agreeable to that. I had discussed with Senator Durbin his
being next in sequence. I think that would be appropriate to lock that
in by unanimous consent.
I am now advised, that even on recognition on our side of the aisle,
we need to check with some other people. But let me say to Senator
Durbin that it will be my effort to have him proceed at that time, but
I want to consult with some of my colleagues, so that is not in the
form of a unanimous-consent request.
Mr. DASCHLE. If the Senator will yield, Mr. President, I say, if we
could have the understanding that as soon as it is cleared on his side
that he would seek recognition for purposes of propounding that aspect
of the unanimous-consent request, I would not have any objection to the
UC request that he currently has proposed.
Mr. SPECTER. I would be delighted to do that, except I am not going
to be on the floor. We have a Governmental Affairs hearing. Let me say
that when we get clearance on this side, it will happen, we will work
it out.
Is the time agreement on the Gorton amendment cleared at this point?
It is?
Mr. President, I ask unanimous consent then that after the conclusion
of the 1 hour of debate on the McCain amendment, we proceed to the
Gorton amendment for 1 hour equally divided, and that at the conclusion
of the vote on the McCain amendment, we will have a discussion as to
sequencing further on the bill and at that time seek to have unanimous
consent to proceed next to the Durbin amendment.
The PRESIDING OFFICER. Is there objection?
Mr. SPECTER. I withhold for just a moment, Mr. President.
Mr. HARKIN. Mr. President, just one moment.
Mr. McCAIN. Mr. President, while they are discussing, may I seek
recognition for a comment?
The PRESIDING OFFICER. The Senator from Arizona.
Mr. McCAIN. Mr. President, I understand now that there would be a
budget point of order raised against my amendment. A budget point of
order, to my understanding, is debatable. I may seek some time to rebut
the budget point of order, so that may affect this unanimous-consent
request, I say to my colleague from Pennsylvania. I do not intend to
take a lot of time, but I intend to take enough time to rebut it.
I thought I would get an up-or-down vote on this amendment.
Apparently, there is going to be a budget point of order. So since the
budget point of order is going to be posed, I feel that aspect of this
issue ought to be addressed.
Mr. SPECTER. Mr. President, if my colleague will yield, could we
enter into a time agreement on how long you would take on that
discussion?
Mr. McCAIN. I would be glad to discuss that. It would be a very brief
period of time, like 10 to 15 minutes.
The PRESIDING OFFICER. The Chair advises the Senator from Arizona,
budget points of order are not debatable.
Mr. McCAIN. The motion to waive the budget point of order is
debatable. That is what I will propose once a budget point of order is
made.
The PRESIDING OFFICER. The Chair advises the Senator that generally
that is true, but if there is a time limitation on the amendment that
has already been agreed to that does not allocate time on debatable
motions, those motions are not debatable. It would be debatable within
the 1-hour time agreement.
Mr. SPECTER. Mr. President, if my colleague will yield, might I
suggest we alter the time agreement to give the Senator from Arizona an
additional 10 minutes to debate the point of order?
Mr. McCAIN. I appreciate that. That would be sufficient.
The PRESIDING OFFICER. Is there objection to the request by the
Senator?
Mr. SPECTER. If the Presiding Officer will withhold for 1 minute,
please, we need to make one more telephone call, so I suggest we
proceed with Senator McCain's amendment, with my leave to interrupt, if
I might when the phone call is made, to complete the unanimous-consent
agreement.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. McCAIN. Mr. President, my understanding is we have 1 hour equally
divided.
The PRESIDING OFFICER. The Senator is correct.

Amendment No. 1091

Mr. McCAIN. Mr. President, this amendment eliminates the financial
incentive payments created under the Balanced Budget Act for teaching
hospitals to reduce their medical residency program. The Federal
Government has created an incentive program which gives hundreds of
millions of taxpayers' dollars to teaching hospitals for not training
medical students.
Mr. President, I strongly suggest if this amendment is defeated,
which I guess in all likelihood it probably will be, that we now
propose amendments that would restrict the number of graduates of law
school. Most Americans believe there are too many lawyers, although
probably the majority of my colleagues would not agree. Perhaps we
should put a cap on the number of graduates of journalism school.
Clearly there are way too many people in that business. And maybe we
should also cap the number of graduates of photography school. That
would cut down on the paparazzi and the problem we have there.
Mr. President, this is not a Republican or Democrat difference. This
is capitalism versus socialism. Vladimir Lenin would be proud of this
proposal for government control, government planning, and, frankly, it
is remarkable that we would have included it even in the way in which
it was included in the Balanced Budget Act, which was over 1,000 pages,
and we had less than 24 hours to review the final draft.
It is just remarkable. It is a new subsidy program. I would like to
read a couple of quotes. My friend from Texas wants to speak on it, so
I will be fairly brief. The payment represents a rare attempt by the
Federal Government to use subsidies as leverage to shrink a particular
work force. ``I know of no profession where there has been as much
federal effort to regulate,'' said Uwe Reinhardt, a health economist at
Princeton University. ``You don't do it for economists, for architects,
for engineers.''
``It is voluntary, but it isn't voluntary for the taxpayers,'' said
the Heritage Foundation.
The National Taxpayers Union supports Senator McCain's amendment to
eliminate the graduate medical education. ``We believe it is a wasteful
use of taxpayers' dollars.''
Others question whether it is necessary. The number of young doctors
training to become anesthesiologists, for example, has declined from
1,500 three years ago to 450 this year following well-publicized
warnings that the field was saturated. Starting a few years ago,
``people weren't able to get the plum jobs in the cities they wanted.
[They] would have to take jobs in Idaho, Oklahoma,'' said James
Kottrell, chairman of anesthesiology at the State University of New
York Health Center in Brooklyn.
Mr. President, 46 million Americans are underserved in health care
today in America. That is a fact and everyone knows it. So now we are
going to pay teaching universities hundreds of millions of dollars of
taxpayers' dollars not to train doctors that are needed.
This morning in the Washington Post--and I ask unanimous consent the
entire article be printed in the Record--was an editorial by Daniel S.
Greenberg, editor of Science & Government Report.
There being no objection, the editorial was ordered to be printed in
the Record, as follows:

Med School Millionaires

(By Daniel S. Greenberg)

[[Page S8960]]

crops, the medical plan was inspired by an immutable law of
American medical practice: More doctors mean more medical
spending, despite the penny-pinching tactics of managed care.
So, stop them before they can start hustling patients, the
Washington strategists concluded. The medical-education
industry, however, is too profitable, inventive and resilient
to yield to that tactic.
The major factor in the medical-production pipeline is
medical-school enrollments. And data compiled by the American
Medical Association show that these have remained virtually
unchanged for more than 15 years, as have the number of
medical schools.
In fact, medical schools have supplanted military bases as
immortal institutions. In 1980-81, the 124 medical schools in
the United States enrolled 65,497 students; in 1996-97, the
number of schools remained duties. Over the past decade, this
income total for faculty at 124, and enrollments stood at
66,712--though a long succession of studies proclaimed a
surfeit of doctors.
The big change in medical education was a vast increase in
revenues, much of it from so-called practice plans that pay
medical faculty for attending to patients, usually in
conjunction with their teaching duties. Over the past decade,
this income total for faculty at the 124 schools has risen
from $5.2 billion to $10.6 billion.
And, in accord with the Willie Sutton principle, the number
of full-time faculty has soared, though the number of
students remains almost unchanged. In 1983-84, the nationwide
faculty totaled 56,564. In the current academic year, the
number of faculty members is 95,568.
Where are they coming from? to a large extent, they were
already there at the university on other payrolls, and were
switched to the more bountiful cash flow of medical
education, which draws on patient fees, federal research and
amply loans to finance runaway tuition fees--to be repaid by
high medical incomes.
A little-known fact of American higher education is that
the highest paid people on many prestigious campuses are not
university presidents. The big bucks go to the medical school
professors. At Columbia University, according to the
Chronicle of Higher Education, the president was pad $317,187
in 1994-95, while one professor of surgery received
$1,526,397 and two others took in more than $1 million
apiece.
At Cornell University, the president received $294,687 in
pay and benefits in 1994-95. A professor of surgery at
Cornell received $1.7 million in pay that year, while two
others each took in over $1.2 million.
The president of New York University was paid $379,000. The
chairman of neurosurgery got $748,342, while four other
medical professors received more than $600,000 each.
At universities without medical schools, pay scales don't
approach these stratospheric medical incomes. At Princeton,
for example, the presidential pay was tops at $305,538, and
the next five highest salaries ranged between $197,796 and
$240,713. At MIT, the president received $285,000, and the
next highest salary was $236,000.
The medical-school industry, in alliance with local
politicians, is eternally resistant to downsizing pleas. The
Pentagon wants to close the medical school that was forced on
it by Congress in 1972, the Uniformed Services University of
the Health Sciences, in Bethesda. The General Accounting
Office says the school is excessive and satisfies only a tiny
proportion of the armed services' physician requirements. But
the school survives.
The Washington lobby for medical schools, the Association
of American Medical Colleges, says the solution to the doctor
surplus is to exclude foreign-trained physicians from
residency slots. The downside to that prescription is that
foreigners are willing to train and practice in inner-city
areas that home-grown physicians tend to shun.
But whatever is done in the quest for surplus reduction,
the odds are that it won't work. The medical-education
industry is too smart and well-connected to be deprived of
its golden goose.

Mr. McCAIN. Reading from the editorial:

Don't expect anything but a hemorrhage at the Treasury from
that new program to counter the doctor surplus by paying
hospitals to reduce the number of residency slots for the
final phase of medical training.
Reminiscent of the agricultural-support schemes that paid
farmers for not growing crops, the medical plan was inspired
by an immutable law of American medical practice: More
doctors mean more medical spending, despite the penny-
pinching tactics of managed care. So, stop them before they
can start hustling patients, the Washington strategists
concluded. The medical-education industry, however, is too
profitable, inventive and resilient to yield to that tactic.
The major factor in the medical-production pipeline is
medical-school enrollments. And data compiled by the American
Medical Association show that these have remained virtually
unchanged for more than 15 years, as have the number of
medical schools.

* * * * *

The big change in medical education was a vast increase in
revenues, much of it from so-called practice plans that pay
medical faculty for attending to patients, usually in
conjunction with teaching duties. Over the past decade, this
income total for faculty at the 124 schools has risen from
$5.2 billion to $10.6 billion.
And, in accord with the Willie Sutton principle, the number
of full-time faculty has soared, though the number of
students remains almost unchanged. In 1983-84, the nationwide
faculty totaled 56,564. In the current academic year, the
number of faculty members is 95,568.
Where are they coming from? To a large extent they were
already there at the university on other payrolls, and were
switched to the more bountiful cash flow of medical
education, which draws on patient fees, federal research, and
ample loans to finance runaway tuition fees--to be repaid by
high medical income.
A little-known fact of American higher education is that
the highest paid people on many prestigious campuses are not
university presidents. The big bucks go to the medical school
professors. At Columbia University, according to the
Chronicle of Higher Education, the president was paid
$317,187 in 1994-95, while one professor of surgery received
$1,526,397 and two others took in more than $1 million
apiece.

Mr. President, I will not complete the article. The medical education
industry is too smart and well connected to be deprived from its golden
goose.
Mr. President, let me read from a quick letter that we got from the
Taxpayers Foundation. This is directed to the Secretary of Agriculture.
Dear Sir: My friends, Wayne and Janelle, over at Wichita
Falls, Texas, received a check the other day for $1,000 from
the government for not raising hogs. So, I want to go into
the ``not raising hogs'' business myself next year.
What I want to know is, in your opinion, what is the best
type of farm not to raise hogs on, and what is the best
breeding hogs not to raise?

The story goes on and on.

I want to be sure that I approach this endeavor in keeping
with all government policies. I would prefer not to raise
Razor hogs, but if that is not a good breed not to raise,
then I can just as easily not raise Yorkshires or Durocs.
As I see it, the hardest part of this program is keeping an
accurate inventory of how many hogs I haven't raised. My
friend Wayne is very excited about the future of this
business. He has been raising hogs for 20 years and the most
he ever made was $420 in 1978, until this year, when he got
your check for $1,000 for not raising hogs.

Mr. President, the letter goes on.

If I can get $1,000 for not raising 50 hogs, will I get
$2,000 for not raising 100 hogs? I plan to operate on a small
scale at first, holding myself down to about 4,000 ``not
raised'' hogs, which will give me $80,000 income the first
year. Then I can buy an airplane. Now, another thing: these
hogs I will not raise will not eat 100,000 bushels of corn. I
understand that you also pay farmers for not raising corn and
wheat. Will I qualify for payments for not raising wheat and
corn not to feed the 4,000 hogs I am not going to raise? I
want to get started not feeding as soon as possible, as this
seems to be a good time of the year to not raise hogs and
grain. I am also considering the ``not milking cows''
business, so please send me any information on that also.

I hope that the Secretary of HHS will be ready to supply various
teaching hospitals around America and people who want to go into the
teaching hospital business how they can qualify for these hundreds of
millions of dollars for not teaching doctors. I believe there will be a
lot of entrepreneurs throughout the Nation that will want to qualify
for a program that pays them hundreds of millions of dollars for not
teaching doctors.
Mr. President, we will have more debate on this. It is a serious
issue. I think it is a defining issue as to what we feel is the role of
Government in our society.
I reserve the remainder of my time.
Mr. GRAMM. Mr. President, let me ask the Senator from Arizona to
yield me 5 minutes.
Mr. McCAIN. I yield 5 minutes to the Senator from Texas.
Mr. GRAMM. Let me begin where Senator McCain left off.
It is a great paradox in a dramatic change in public programs
subsidies. So, therefore, we are moving toward ending the practice of
paying people not to produce things we do not want.
What an incredible paradox it is. At the very moment that we are
getting out of the business of paying people not to produce
agricultural products, the Federal Government is on the verge of paying
medical schools not to train doctors.
Let me explain how the program came about and how it works and then
try to end up as quickly as I can by explaining to people why, as
chairman of the Medicare subcommittee, I am for the McCain amendment.
First of all, we set up a program to fund graduate medical education.
It

[[Page S8961]]

was done a long time ago, but in essence, we were running a surplus in
Medicare, so rather than coming up with a funding mechanism for
training doctors, Congress simply reached into Medicare and took the
money away from beneficiaries and from payroll taxpayers to fund
graduate medical education.
It is an outrage that with Medicare on the verge of being insolvent,
we are still plundering the Medicare trust fund to pay for graduate
medical education. I believe that should end.
Basically, we have an entitlement program run by the Department of
Health and Human Services which pays teaching hospitals for residents
to be trained in various specialties. The average subsidy is about
$100,000 a year per slot. About $35,000 of that amount goes to the
resident and $65,000 to help fund the cost of graduate medical
education.
Now, there is virtual unanimity that we are training too many doctors
and too many specialists. Rather than going back and eliminating the
entitlement or reducing the payment for the entitlement so that fewer
schools will be providing the training to fewer students, Congress was
afraid to change the program. It simply lacked the political courage to
cut these entitlements to graduate medical schools.
So HCFA initiated a pilot program in one State, New York, and started
paying medical schools not to train doctors.
Basically it works like this: If the teaching hospital agrees not to
train a doctor they otherwise are entitled to receive funding to train,
then we pay them the money. Interestingly enough, in the first 2 years
of the program we are going to pay them $100,000. Yet by not training a
resident, they do not have to pay a resident $35,000. So now they are
getting $35,000 more for not training the doctor than they got for
training the doctor during the first 2 years.

Now, basically, this is an absurd situation. The idea we are taking
the taxpayers' money and paying people not to train doctors is almost
unbelievable. If you went out and did a survey of the American people
and asked them about this program, they would not believe the
Government would be doing this. But not only are we doing it in a very
small provision in this budget bill we passed, a provision that most
Members knew absolutely nothing about, we are expanding this program
from just New York to the whole country. So we are going to be paying
people all over America not to train physicians.
The PRESIDING OFFICER. The Senator from Texas has used the 5 minutes.
Mr. GRAMM. I yield 1 additional minute and I will be through.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. GRAMM. There will be people who come over and say, well, in the
long run, it will save us money to pay medical schools not to train
doctors. My response is that this is an absurd program. We ought to
stop doing it. We ought to end the program right here on the floor of
the Senate today. Then the committee can go back, because it will be
forced to do something about the program, and come up with a coherent
program to reduce the overall subsidy.
But we should not get into a situation where we are doing in medicine
what we did in agriculture for years and years and years, and that is
paying people to not produce things that we do not want.
It is unimaginable this has occurred. Yet it has. It needs to be
stopped. I want to urge my colleagues to vote for the McCain amendment,
and then all the technical things that need to be fixed about it we
will fix later.

Unanimous-Consent Agreement

Mr. SPECTER. I think we are now ready for the unanimous consent
request which I now propound.
I ask unanimous consent that the debate on the Gorton amendment No.
1122 be limited to 1 hour equally divided, that no amendments be in
order to the Gorton amendment, and the Gorton amendment will be subject
to a tabling motion at that time at the conclusion or yielding back of
time.
Let me specify, so there is no doubt, the 1 hour of debate would be
prior to the motion to table.
The PRESIDING OFFICER. Is there objection to the unanimous consent
request?
Without objection, it is so ordered.
Mr. SPECTER. Just to be clear, I want to be sure that we have an
additional 10 minutes for the Senator from Arizona, in addition to his
1 hour, on the point of order which may be raised.
I ask unanimous consent that, in addition to the 1 hour on the McCain
amendment, in the event a point of order is raised, Senator McCain will
have an additional 10 minutes to debate that.
The PRESIDING OFFICER. Without objection--
Mr. HARKIN. Reserving the right to object, Mr. President. As I
understand it, the unanimous consent would be that after the hour of
debate, equally divided, under the McCain amendment, since points of
order are not debatable, it would be a motion to waive. If there is a
motion to waive the point of order, that would be debatable, and
Senator McCain wants 10 minutes under that process.
Mr. SPECTER. That is correct. It was more precisely stated. It is 10
minutes to debate the motion to waive the point of order.
Mr. HARKIN. I would want to have 10 minutes in the event somebody
over here wants to speak. So I would like it to be 10 minutes for
Senator McCain and 10 minutes on this side.
Mr. SPECTER. With that modification, I propound the request.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. SPECTER. So that our colleagues may be aware of the sequencing,
Mr. President, the debate on the McCain amendment, the first hour
should run at approximately 3:40, and the conclusion on a motion to
waive would be either at 3:50 or 4 o'clock, then an hour of debate on
the Gorton amendment, and then there would be a vote on the McCain
amendment. And in between, votes to be stacked on McCain and Gorton and
after the vote on the McCain amendment, we will try to reach time
agreements on the remaining amendments and try to clear at that time an
agreement that Senator Durbin proceed next on his amendment. I thank
the Chair.
Mr. HARKIN. If the Senator will yield. For the benefit of Senators,
what we are looking at right now is probably two votes that will take
place at about 4:45 or 5 o'clock.
The PRESIDING OFFICER. Who yields time?
Mr. SPECTER. Mr. President, in the absence of any other Senator
seeking recognition, I ask unanimous consent that the pending amendment
be set aside.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendments Nos. 1119, 1120, 1109, 1092, 1121, 1085, 1086, and 1093, En
Bloc

Mr. SPECTER. Mr. President, I ask unanimous consent that the
following pending amendments be considered, en bloc: amendment No. 1119
by Senator Murray, providing for an additional $1 million for the
National Institute of Literacy; amendment No. 1120 by Senator Bennett
regarding school trust lands; amendment No. 1109 by Senator Nickles
regarding the Social Security Administration and the reporting of
employer contributions; amendment No. 1092 authored by Senators McCain
and Kerry, regarding eligibility for benefits under Medicaid and SSI;
amendment No. 1121, authored by Senator Kerrey, regarding child care
funding allocation errors; amendments numbered 1085 and 1086 by
Senators Durbin and Levin, regarding organ donation; amendment No. 1093
authored by Senators Craig and Bingaman regarding the maximum hour
exemption for certain agricultural employees.
Mr. President, I further ask unanimous consent that Senators Roth and
Moynihan be added as cosponsors to amendment No. 1109.
Each of these amendments I am advised, are appropriately offset and
have the approval of both managers, as negotiated by staffs, and with
the authorizing committees where necessary. I ask unanimous consent
that the amendments be agreed to, en bloc.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The amendments (Nos. 1119, 1120, 1109, 1092, 1121, 1085, 1086 and
1093) were agreed to.

amendment no. 1085

Mr. DURBIN. Senator Levin will be offering a sense-of-the-Senate
amendment that complements this amendment. I want to commend him for
his

[[Page S8962]]

hard work in this area since 1979 when he succeeded in instituting
directives aimed at increasing the number of military organ donors.
Senator DeWine's staff has also been most helpful in suggesting
modifications to improve this amendment and we have incorporated all
their suggestions into this amendment.
More than 50,000 Americans are waiting for organ transplants and
hundreds of thousands more need tissue transplants. Every year,
thousands die needlessly due to lack of donors. In 1996 alone, 3,916
people on the transplant waiting list died because no organs were
available for them. Nearly one-fifth of all heart and liver transplant
candidates die while waiting for organs. Every 18 minutes another
person is added to the waiting list for organs. Each day, eight people
die because an organ was not available. Yet since 1986, hospitals that
participate in the Medicare or Medicaid Program are required to have in
place policies to offer eligible families the option of organ and
tissue donation. Last year at an HHS hearing on liver allocation and
organ donation, Michael Evanisko, president of the Partnership for
Organ Donation testified that at least half of the solution to the
organ donor shortage could be achieved by focusing on hospital
practices. The partnership's research with 11 organ procurement
organizations and over 130 hospitals nationwide, in conjunction with
the Harvard School of Public Health and Harvard Medical School,
estimated that:

* * * if hospitals adopted optimal organ donation
practices, an additional 5,000 donors would result, bringing
the effectiveness of the donation system from one-third to
nearly 70%.

The major impediments to donation, according to Evanisko, are whether
families are approached about donation and how the request is handled.
Last year, Senators Dorgan and Frist here in the Senate joined forces
with myself and Dave Camp in the House and we added a section to the
Kassebaum-Kennedy Health Portability Insurance Act, which resulted in
taxpayers who were receiving a tax refund this year, at the same time
received an organ donation request card. An estimated 70 million
Americans received this solicitation. Those of us who worked hard to
incorporate that provision into the bill, certainly hope that it will
increase the number of organ donors. However, increasing the numbers of
individuals with organ donor cards alone will not save lives, if
hospitals do not effectively identify these eligible donors.
Approaching families in a sensitive manner about organ donation is also
extremely important.
My amendment would ask HHS together with GAO, to survey 5 percent of
the donor hospitals in order to ascertain how the program is working
nationwide. This information could be used to determine best hospital
practices. This amendment complements our previous efforts to maximize
the numbers of lives saved for those in need of organ or tissue
transplants.
Mr. DeWINE. Mr. President, I rise today to support an amendment
offered by my colleague from Illinois, Senator Durbin. The Senator's
amendment calls for a report to identify the best ways to recover
organs and tissue from those who have died suddenly so that the lives
of others can be saved through organ transplants.
Today, more than 54,000 Americans are waiting for an organ
transplant; and 10 Americans will die each day before an organ can be
found. And the sad fact is that these deaths are preventable. We have
the technology to give these people a second chance through
transplants--but while we have the technology, we don't have the
organs.
I am convinced that much of this problem can be solved by making
people aware of this problem and educating them about the need for
organ donation. And I have been working on that for some time.
However, just as important is looking at the system we have in place
for organ procurement--to see if there are structural hurdles that we
can help remove. The law today requires hospitals to have a protocol in
place for organ procurement. Not all do. Those that do don't
necessarily work with the organ procurement organizations [OPO's] in
their local areas. These are the hurdles that Senator Durbin's
amendment tries to address. The study that this amendment requires is
an important one. I hope that it will provide us all with information
about how best to identify appropriate organ donors and then, how best
to approach their families. I would hope that this study would take
into account the fact that these best practices may well be different
in different parts of the country. To the extent the Secretary can
identify these differences in her report, I think it would be
meaningful to the hospitals and their respective OPO's.
When we fail to identify a potential donor or bungle our
communication with a potential donor's family, we compound an already
tragic situation. Already someone's family member--a mother, brother,
or sister--has died. The second tragedy is that--despite that person's
willingness to donate and save another's life--that wish is ignored or
the request to the family is handled poorly, raising unnecessary doubts
about donation.
I'd like to thank Senator Durbin--I appreciate his thoughtful efforts
toward increasing organ donation and improving organ procurement. I
also want to thank him for accommodating my concerns in his amendment.
I look forward to working with him in the future on this issue that is
so important to both of us.

amendment no. 1086

Mr. LEVIN. Mr. President, the need for organ transplants has
continued to outpace the availability of transplantable organs.
However, studies have shown that this trend can be reversed by
improving the process that families experience in hospitals. Congress
recognized the vital role that hospitals can play in organ donation
when it enacted legislation to require hospitals to be responsible for
facilitating organ donation. The Omnibus Reconciliation Act of 1986 and
subsequent legislation, requires organ procurement organizations and
hospitals to establish organ donation protocols to enable hospitals to
initiate requests, on a routine basis, for organ donation.
A recent Harvard School of Public Health study, based on the
examination of thousands of medical records in 125 hospitals in four
regions of the United States, found that despite the legal
responsibility to inform surviving family members of donation options,
many hospitals frequently fail to do so. According to the study, 27
percent of potential donors were lost either because health
professionals did not identify potential donors or did not ask families
about organ donation.
Mr. President, the amendment I am offering today seeks to bring
attention to the potential of hospitals to alleviate the donor
shortage, and to shed some light on the fact that hospitals can improve
their donor policy by instituting demonstrated best practices in organ
donation. There are a number of major initiatives underway focusing on
hospital practices in organ donation that can result in saving
thousands of additional lives in the not-too-distant future.
For example, the Michigan Hospital Association (MHA) is embarking on
an important initiative to encourage its members to improve their organ
donation effectiveness. It includes identifying stragies designed to
improve the organ donation consent process and examining all aspects of
the process, from community education to provider interaction with the
family. The initiative will also generate specific recommendations to
improve the tissue donation process, as well as major organ
procurement.
The Association of Organ Procurement Organizations is in the midst of
a major pilot project to conduct reviews of deaths that have occurred
in hundreds of hospitals across the country. This project will provide
an unprecedented level of information on organ donor potential and
performance and lead to targeted strategies to help hospitals improve
their effectiveness.
Additionally, The Partnership for Organ Donation, in collaboration
with the University HealthSystem Consortium (an alliance of 70 academic
health centers), has begun a major initiative to improve organ donation
practices in hospitals across the country. The goal is to increase
organ donation significantly in these hospitals by institutionalizing
best-demonstrated practices. The project follows an ``action research''
design, which includes diagnosing hospital performance, building

[[Page S8963]]

consensus on the donation protocol, establishing a donation team in the
hospital, educating all relevant staff in-depth, enacting the new
protocol, and on-going monitoring for quality assurance. The project
ultimately will lead to practice guidelines for organ donation, which,
if adopted nationwide, could provide organs for many of the 53,000
Americans currently awaiting transplants. it is currently being
implemented in a number of leading hospitals, including Henry Ford
Hospital in Michigan, Virginia Commonwealth University's Medical
College of Virginia Hospitals, University of Iowa Hospitals and
Clinics, Oregon Health Sciences University Hospital and Clinics, Ohio
State University Medical Center, Medical College of Ohio, St. Vincent
Medical Center of Ohio and Riverside Hospital in Columbus, Ohio.
Collectively, these innovative endeavors will prove that patterns of
nondonation can be modified. Mr. President, my amendment is aimed at
encouraging hospitals to alleviate the donor shortage and sheds some
light on demonstrated best practices that can improve organ donation in
hospitals. It also expresses the sense of the Senate that hospitals
that have significant donor potential shall fulfill their legal
responsibility to assure a skilled and sensitive request for organ
donation to eligible families. The Harvard study estimated that 5,600
additional lives could be saved each year if hospitals improved their
practices relative to donation requests. A Gallup survey indicated that
85 percent of the American public supports organ donation, and 69
percent describe themselves as likely to donate their organs upon
death.
Mr. President I understand that the amendment has been accepted. I
thank the managers of the bill for their support. I would also like to
acknowledge the support and cosponsorship of this amendment by Senator
Thurmond, Senator Durbin, Senator Inouye and Senator Dorgan. Mr.
President, I understand that the managers will also accept the Durbin-
Levin amendment requesting the U.S. Department of Health and Human
Services together with the General Accounting to conduct a
comprehensive survey of donor hospitals to ascertain:
(1) the differences in protocols for the identification of potential
organ donors
(2) whether each hospital has a system in place for such
identification of donors, and
(3) protocols for outreach to the relatives of potential organ or
Tissue donors.
The report will also include the Secretary's recommendations on the
most efficient and comprehensive practices for identifying organ and
tissue donors and for communicating with relatives of potential organ
donors.
I commend Senator Durbin for all of the innovative work he is doing
in the area of organ donation. Of particular note is Senator Durbin's
Organ Donation Insert Card Act which was enacted into law over a year
ago that I was pleased to cosponsor. The insert card is included along
with the tax refunds to millions of Americans giving them the
opportunity to indicate if they want to become an organ donor.
Mr. President, these organ donor measures, including my negotiations
over the past decade with Department of Defense Health officials to
increase the number of military organ donors, complement efforts to
maximize the numbers of lives saved for those in need of organ or
tissue transplants. I am encouraged that the two Department of Defense
Directors instituted a number of years ago will result in every member
of the military having an opportunity to indicate if they wish to
become a donor. Under the Directive:

Unless contra-indicated medically, legally, or for
religious reasons, organ and tissue donation shall be
discussed with next of kin in every death in a military
Medical Treatment Facility including Uniformed Services
Treatment Facilities.

Additionally, the Department of Defense has instituted the process of
including organ donor information in the Defense Enrollment Eligibility
Reporting System (DEERS). In April of 1995, the Department reported a
30 percent positive response to this directive, which had not yet been
fully implemented.

Amendment No. 1109

Mr. NICKLES. Mr. President, in 1989, Congress enacted legislation
that requires that the Social Security Administration provide workers
with regular statements about the value of their Social Security
benefits. SSA is required to send these forms--known as the Personal
Earnings and Benefit Estimate Statements (PEBES)--to any eligible
individual who requests one and was mandated to send an annual PEBES to
each eligible workers over the age of 59 in 1995.
In FY 2000, the Secretary will be required to send this form annually
to all eligible workers over the age of 25--An estimated 123 million
Americans are expected to receive this form in FY 2000. The SSA
projects that the cost of administering this law in FY 2000 will be $80
million.
These forms are specifically designed to help beneficiaries
understand the value of their Social Security benefits. While I agree
with the stated goal of the PEBES forms, I do not agree that the PEBES
form in its current design meets the test of providing that
information. In fact, I believe that in its current structure the PEBES
form is misleading to beneficiaries.
Right now, individuals are provided an estimate of their retirement
benefit. They are provided a yearly breakdown of their reported
earnings, and a yearly breakdown of the taxes he or she paid. What is
NOT reflected in this statement is the employer's contribution. My
amendment will require the Social Security Administration to include
the employer's contribution on the PEBES statement.
By not including the employer's contribution, the form misleads
workers on the actual amount of money being contributed into Social
Security on their behalf and distorts the true rate of return on their
taxes.
Most people think that FICA represents 7.65 percent of their wages.
Actually, it is twice that when you consider the employer's
contribution totaling 15.3 percent--12.4 percent designated Social
Security and 2.9 designated to Medicare.
Mr. President, the employer share of FICA is a labor cost. This is a
cost of employing somebody in this country. This is compensation that
is not available to go to the employee but instead is contributed on
their behalf through FICA taxes. While we refer to this as the employer
share, in reality this additional 7.65 percent comes out of the
employee's compensation.
The PEBES is only telling half the story. Omitting the employer's
share of FICA is a gross misrepresentation. The worker who looks at his
or her statement will falsely assume that their estimated benefit is
providing them a much higher rate of return. In fact, the rate of
return is much lower because the taxes that a person is paying is
actually TWICE what the PEBES form indicates.
The PEBES form does provide for representation of the self-employed
share, however, those workers who are not self-employed are not getting
the truth about the performance of their Social Security taxes.
Mr. President, my amendment is simple. It will require that we are
honest to taxpayers about not only what their full benefits will be but
that we are also honest on what the full cost of those benefits are. If
we are going to take the time and resources to educate workers on their
benefits we should ensure that it is done honestly and correctly.
Frankly, I believe that we would improve the PEBES form even more by
tackling some of the issues that Senator Grams has laid out in his
legislation Workers should be informed on the real rate of return on
their taxes; they should understand how the Social Security program is
performing compared to the private market; and finally, when the Social
Security Administration projects benefit estimates they should also be
required to inform beneficiaries that the trust fund won't be able to
pay benefits after 2029.
I am pleased that this amendment has been accepted by the managers of
the bill and I believe it will help improve one of the few tools
available to us in educating the public about planning for their
retirement.

amendment no. 1093

Mr. CRAIG. Mr. President, I am pleased that the Senate is considering
today an amendment I am offering with Senators Bingaman and Domenici.
This amendment to S. 1061 would make a change to the Fair Labor
Standards Act (FLSA) that is narrow

[[Page S8964]]

in scope, but is of critical importance to irrigators in Idaho and the
West.
Our amendment solves a problem with the interpretation of a provision
of the FLSA.
Currently, nonprofit organizations that deliver water for
agricultural purposes--such as water districts organized by local
governments, co-ops, and non-profit corporations--are exempt from the
maximum-hour requirements of the FLSA.
However, according to the Department of Labor, if even one drop of
this water is used for purposes it considers ``non-agricultural'', then
the water delivery organization loses its exemption and severe
penalties can be imposed. This is true even for minimal or incidental
uses, such as road watering, lawn and garden irrigation, or livestock
consumption. Such uses may be closely related to, but technically not
interpreted as being, ``agricultural purposes''.
Our amendment clarifies that the maximum hour exemption applies to
water delivery organizations that supply 90 percent or more of their
water for agricultural purposes.
The work being done for these organizations is very seasonal.
Irrigation has never been, and can not be, a 40-hour-per-week, 12-
months-a-year, undertaking. During the summer, water must be managed
and delivered continually. Later in the year, following the harvest,
the work load is light, consisting mainly of maintenance duties.
Our amendment is better for employers, workers, and farmers.
If a water delivery organization is forced to pay overtime during the
summer, it will have to lay off workers in the winter. Then it will
hope that skilled, specialized workers, who know the equipment and the
area, are available again next spring. Our amendment solves this
problem, by promoting a stable work force and level costs, year-round.
This adjustment also helps ensure year-round incomes and job security
for employees.
Our amendment restores the flexibility that traditionally existed and
was always intended by Congress. It more accurately reflects the
realities of agricultural water delivery.
Representative Mike Crapo of Idaho has introduced a similar measure
in the other body. It is our hope that this adjustment finally will
become law this year.
Finally, I want to acknowledge a former member of my staff, who is
now an attorney in Idaho, Norm Semanko. Norm actually began work on
this amendment some time back and laid the groundwork that has led up
to its adoption by the Senate today. My staff still refers to this
amendment as the Semanko Act.
I understand this amendment will be accepted on both sides. I thank
the managers of the bill for their support and assistance; the chairman
and ranking member of the Labor and Human Resources Committee, with
whom we consulted; and Senator Bingaman and his staff for their strong
efforts on behalf of this amendment.
Mr. BINGAMAN. Mr. President, I'm cosponsoring this amendment to
section 13(b)(12) of the Fair Labor Standards Act, to make this law
reflect the on-farm realities in the West. I believe this amendment
follows what must have been the true intent of legislation in the first
place. Section 13 is a long list of occupations that for one reason or
another we have exempted from the various overtime requirements of the
law. Section 13(b)(12) in particular exempts employees of irrigation
districts.
The reason for this exemption has to do with the requirements of
farming in the arid West. In my home state of New Mexico, for example,
we usually have two to three months each year, from about mid-May to
the end of July, where we get little or no rain. This yearly dry spell
is right at the height of the dry season, and if a farmer can't
irrigate his crops they die. Because of the expense of irrigation
systems, most farmers belong to an irrigation district that maintains a
system of canals and ditches to supply water to their fields. Most
irrigation districts employ their ditch riders year round so that they
know the system, the individual farms, and the needs of each farmer in
the district, and don't have to relearn the process every year. With
year-round employment these folks are an integral part of the farm
community. However, the work these people do is very seasonal.
Typically, a ditch rider will work long and hard hours during the
summer irrigation season, and have a relatively lax work schedule the
rest of the year. In enacting section 13(b)(12), Congress recognized
the importance that year-round employment has for both the ditch riders
and their families, and the farming community. However, it appears that
in acknowledging the unique working conditions required for western
farms, that the law was written too narrowly. The current section
exempts:

. . . any employee employed in agriculture or in connection
with the operation or maintenance of ditches, canals,
reservoirs, or waterways, not owned or operated for profit,
or operated on a share-crop basis, and which are used
exclusively for supply and storing of water for agricultural
purposes.

The phrase ``exclusively for supply and storing of water for
agricultural purposes,'' has recently been interpreted by rulings in
the 9th and 10th Circuit Courts to mean that all of the water from a
district's system must be used for irrigation or the district loses the
exemption.
This strict all or nothing approach just doesn't match with the
reality of western farming communities and the day-to-day life on a
western farm. In the dry and dusty summer months it is very typical for
farmers to use of their irrigation water for dust control, and for
watering their lawns and flower beds. That is just human nature.
However, the vast majority of water is used for growing crops.
Mr. President, this amendment, which changes the exemption to
required that ``at least ninety percent'' of the water be used for
agriculture, merely reflects a practical application of this long
established exemption. As the irrigation season is just winding down
for this year, the farm districts will soon be making decisions
regarding whether to retain their ditch riders in light of the recent
court rulings. With this in mind, I ask my colleagues to accept this
amendment now, so that there won't be any disruption to these people's
lives.

amendment no. 1120

Mr. BENNETT. Mr. President, in the Federalist Papers, Madison tried
to allay fears of a Federal government overpowering state and local
concerns, by stating:

. . . where on one occasion improper sacrifices have been
made of local considerations to the aggrandizement of the
federal government, the great interests of the nation have
suffered on a hundred from an undue attention to the local
prejudices, interests, and views of the particular States.
. . . But what degree of madness could ever drive the
federal government to such an extremity?--Federalist Paper,
No. 46.

Mr. President, while Mr. Madison believed that Federal encroachment
of local interests would be rare, I believe the State of Utah finds
itself in that circumstance. Utah's education budgets are being
improperly sacrificed by federal action. Mr. Madison predicted that
legislative devices would be used to solve these types of problems. He
was right. Today I am offering an amendment in an attempt to do just
that.
Last September, the President created the 1.7 million acre Grand
Staircase-Escalante Monument in Utah. While I vehemently disagreed with
the process the Administration used to designate this monument, it is
now a fixture on our map. We must now move on and work toward resolving
the problems that were created by this Proclamation.
One of the most important issues that must be addressed are the
176,000 acres of school trust lands trapped within the boundaries of
the monument. For those of you who are not familiar with school trust
lands, let me briefly explain. At statehood, the federal government
granted about one-ninth of the lands in Utah for the support of public
education. School trust lands exist solely to generate revenue for
public schools.
President Clinton, in designating the monument acknowledged the
impact to state education funds. He stated, ``I know the children of
Utah have a big stake in school lands located within the boundaries of
the monument that I am designating today . . . creating this national
monument should not and will not come at the expense of Utah's school
children.'' Utah's citizens, and

[[Page S8965]]

education groups, including the Utah's Education Association, the
Parent-Teacher Association, the School Boards Association, the State
Board of Education, the School Superintendents Association, the
Association of Elementary School Principals, the Association of
Secondary School Principals, and School Employees Association agree,
and have spoken loudly and clearly about the need to solve this problem
for the benefit of Utah's school children.
President Clinton then directed the Interior Department to conduct a
land exchange of school trust lands located within the Monument. While
this is one of the most realistic solutions to this problem, it will
not be easy. Land exchanges are expensive, time-consuming, and
unfortunately, will negatively impact tight State education budgets. In
a May 14 report on the Grand Staircase-Escalante Monument, the
Department of Education reached the following conclusion:

The Department [of Education] recognized that the process
of arranging for land exchanges exacts costs on the State of
Utah . . . These costs are paid from funds that would
otherwise be available for public education.

Mr. President, this amendment provides a grant to the Utah State
Education Agency to partially defray expenses of conducting a land-
exchange. State education funds are badly needed to educate Utah's
children.
I would like to thank Senator Specter and Senator Harkin for their
assistance, and leadership in education. I look forward to working with
them, the Department of Education and the Administration on this issue,
and appreciate their willingness to work with me.

Amendment No. 1111

Mr. SPECTER. Mr. President, I ask unanimous consent that the pending
amendment be set aside and that the Senate turn to the consideration of
amendment No. 1111 to Senate bill 1061.

Amendment No. 1123 to Amendment No. 1111

(Purpose: To assure the Medicare Commission examines the role of
medical research and long-term care in the future of Medicare)

Mr. HARKIN. Mr. President, I send an amendment to the desk and ask
for its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The bill clerk read as follows:

The Senator from Iowa [Mr. Harkin], for himself and Mr.
Feingold, proposes an amendment numbered 1123 to amendment
No. 1111.

Mr. HARKIN. Mr. President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

At the end of line 3 in the pending amendment insert the
following: ``: Provided further, That in carrying out its
legislative mandate, the National Bipartisan Commission on
the Future of Medicare shall examine the role increased
investments in health research can play in reducing future
Medicare costs, and the potential for coordinating Medicare
with cost-effective long-term care services''.

Mr. HARKIN. Mr. President, this amendment provides $900,000 for the
first year costs for the bipartisan Commission on Medicare authorized
in the Balanced Budget Act of 1997. The additional funds are fully
offset.
The PRESIDING OFFICER. Is there further debate on the amendment?
Mr. SPECTER. That amendment is agreeable to this side of the aisle.
The PRESIDING OFFICER. The question is on agreeing to the second-
degree amendment.
The amendment (No. 1123) was agreed to.
Mr. SPECTER. Mr. President, I move to reconsider the vote.
Mr. HARKIN. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The question is on the amendment, as amended.
The amendment (No. 1111), as amended, was agreed to.
Mr. SPECTER. I move to reconsider the vote.
Mr. HARKIN. I move to lay that on the table.
The motion to lay on the table was agreed to.
Mr. HARKIN. I ask unanimous consent that the Record be corrected to
reflect that amendment No. 1115 is a Harkin amendment, cosponsored by
Senators Bingaman and Kennedy.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. HARKIN. I ask unanimous consent that Senator Bingaman be added as
a cosponsor to amendment No. 1101.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCAIN addressed the Chair.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. McCAIN. How much time is remaining on both sides on the pending
McCain amendment?
The PRESIDING OFFICER. The Senator from Arizona has 15 minutes 30
seconds. The Senator from Iowa has 21 minutes.
Mr. McCAIN. Mr. President, I yield myself 5 minutes.
Mr. HARKIN. If the Senator will withhold, will the Senator yield for
a unanimous-consent request?
Mr. McCAIN. Yes.

Privilege of the Floor

Mr. HARKIN. Mr. President, I ask unanimous consent that Janet
Goldberg, a detailee in my office, be permitted privileges of the floor
on the debate of the Labor, Health and Human Services appropriations
bill.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from Arizona is recognized.

Amendment No. 1091

Mr. McCAIN. I yield myself 5 minutes, and then I hope that the
opponents of the amendment will use part of their time because I don't
intend to use all of my time since I would like to save some time at
the end.
Mr. President, there is going to be a budget point of order. I will
respond to that at the right time. I remind my colleagues that the
provision contained in the Balanced Budget Act was not contained in the
balanced budget bill passed by the full Senate. The full Senate never
had the opportunity to review this provision. Not only did the Senate
not have the opportunity to debate this provision when we considered
the budget bill in June, we were not given sufficient time to clearly
examine the budget bill after conference.
The Balanced Budget Act is over a thousand pages, and we had less
than 24 hours to review the final draft after receiving it from the
conferees. Mr. President, it is also well known that a provision
originally was going to be included that would affect only the State of
New York, and then it was expanded to the entire country.
Mr. President, I just read a very amusing--at least to me --letter
from a fellow that wanted to not raise hogs or not grow grain. I have
been amused somewhat by this proposal that we would pay teaching
hospitals not to teach, or pay farmers not to grow, or to pay anybody
not to do something. It is somewhat amusing, but at the same time,
occasionally in this debate we should focus on the fact that there are
46 million Americans who still lack access to doctors and medical care
in America.
Here we have a situation where, according to the Health and Human
Services Department, 46 million Americans don't have access to health,
doctors, and medical care, yet, now we are going to restrict the supply
of doctors in America. It flies in the face of every fundamental belief
that I have, ranging from what capitalism and the free enterprise
system is all about to what our obligations as a society are.
If we are going to restrict the number of doctors, how in the world
are we supposed to take care of these 46 million Americans who live in
rural communities and inner-city neighborhoods and have shortages of
physicians and health care professionals? The very poorest people in
America, Mr. President, are the ones who don't have health care, and
now we are going to deprive them of the possibility of treatment?
There are programs that serve underserved areas, including the
National Health Service Company, Area Health Education Centers,
Interdisciplinary Training for Health Care in Rural Areas, Community
Health Center, Migrant Health Centers, and the Health Professions Work
Force Development Program.
I hope that my colleagues will join me in rejecting this proposal
that somehow we are helping Americans by restricting the number of
doctors. Mr. President, in its own bizarre fashion,

[[Page S8966]]

the CBO is claiming this will cost the American taxpayers money. I find
it bizarre. I find it incredible. And the fact is that if we are now
going to accept the assumption of the CBO that we save money by not
having teaching hospitals teach, then clearly we can save money by not
having other organizations in America that receive Federal subsidies do
their job as well. It seems that it is only the medical profession that
seems to be able to get away with this.

By the way, Mr. President, this experiment ``* * * will pay hospitals
in the State''--the State of New York, not the entire country but just
in the State of New York--``$400 million over the next several years,
while they gradually decrease the number of young doctors they train.''
My understanding is that there will be no change for the first 2
years of this.
That experiment ``* * * drew an outcry from teaching hospitals
elsewhere that felt New York had wrangled a lucrative special deal.
Their protests attracted the sympathy of congressional Republicans who
decided that, instead of trying to block money for New York, they would
expand the opportunity nationwide.''
To quote further:

The payments represent a rare attempt by the Federal
Government to use subsidies as leverage to shrink a
particular work force. ``I know of no profession where there
has been as much Federal effort to regulate,'' said Uwe
Reinhardt, a health economist at Princeton University. ``You
don't do it for economists, for architects, for engineers.''
The payments also are the government's first effort to
constrict the pipeline of people entering the medical
profession. Several influential groups have warned lately
that the nation has too many doctors, particularly
specialists, and have urged the federal government to impose
limits on the number of recent medical school graduates,
known as residents, who pursue several years of advanced
training before beginning to work on their own. But until now
that advice has met with legislative resistance.
The New York experiment and the nationwide initiative hinge
on changes in Medicare, the largest federal insurance program
for the elderly and disabled. Since it began, Medicare has
underwritten residency training programs heavily and has, in
effect, made residents a prized, inexpensive kind of labor
for their hospitals. Taxpayers spend $7 billion a year on
such training.
Until now, many teaching hospitals have been reluctant to
cut back, because every resident translates into an average
subsidy of $100,000 a year. ``It has not been financially
rewarding to downsize,'' said Muncey Wheby, associate dean
for graduate medical education at the University of Virginia.
Under the budget agreement, hospitals that downsize will
not get extra money outright. But if they volunteer to reduce
their residency programs by 20 percent or 25 percent over
five years, Medicare will cushion the financial blow. For the
first two years, it will pay the whole subsidy for the
missing residents. After that, the payments will taper off
for three years.
The agreement also for the first time essentially forbids
hospitals to increase the sizes of their residency programs.

Mr. President, the article goes on with other suggestions:

But others suggest that hospitals will be rewarded
needlessly for cutbacks that some have started to make
without being paid to do it. Some say the initiative is the
medical equivalent of discredited agricultural programs that
have paid farmers not to grow certain crops.
``I don't know where the hell as Republican Congress gets
off doing labor force planning for the medical profession,''
said Robert E. Moffit, deputy director for domestic policy
studies at the Heritage Foundation, a conservative think
tank. ``As an economic principle, it is absurd.''
How many physicians the nation produces has important
effects on the cost of the health care system. The greater
the number of doctors, research has shown, the more medical
tests and expensive specialty treatment patients tend to
receive, because physicians find subtle ways to keep
themselves employed.
With more than 700,000 physicians, the United States has
more doctors per capita than virtually any other country. In
particular, it has a vast supply of specialists, who are
starting to find themselves in less demand as more patients
are insured through ``managed care'' plans that favor
treatment by lower-cost medical generalists.

Mr. President, I reserve the remainder of my time. I yield the floor.
The PRESIDING OFFICER (Mr. Kempthorne). Who yields time?
Mr. McCAIN. Mr. President, in light of the fact that I am the only
one here on the floor, I ask unanimous consent that the time be taken
off the time of the opposition to the amendment.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered.
Mr. McCAIN. Mr. President, I suggest the absence of a quorum, and ask
unanimous consent that the time be taken from the opposition to the
amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. McCAIN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCAIN. Mr. President, could I ask how much time remains on both
sides?
The PRESIDING OFFICER. The Senator from Arizona controls 7 minutes;
the opposition controls 4 minutes and 53 seconds.
Mr. McCAIN. Mr. President, I know that the opponents of this
amendment would like to make some comments.
Oh, here is one right now.
Mr. DOMENICI. Mr. President, I seek recognition.
The PRESIDING OFFICER. Who yields time?
Mr. DOMENICI. Who is the opposition?
I guess I am the opposition.
The PRESIDING OFFICER. The Senator from New Mexico is recognized.
Mr. DOMENICI. How much time do I have?
The PRESIDING OFFICER. The Senator has 4 minutes 50 seconds.
Mr. DOMENICI. Who dealt away all my time in opposition?
The PRESIDING OFFICER. It was running during the quorum call.
Mr. DOMENICI. First let me apologize. I was at the Senate Committee
on Governmental Affairs. Frankly, of all the times you could have, I
was actually asking questions. But I do not need any more time.
Mr. McCAIN. I was just going to say I ask unanimous consent to give
the Senator from New Mexico some additional minutes if he would need
them.
Mr. DOMENICI. Mr. President, I do not need anything. The only thing
is, did the distinguished chairman of the Finance Committee, Senator
Roth, speak?
Mr. McCAIN. No.
Mr. DOMENICI. I am wondering if he would like to speak.
That is the reason I raised this, I say to the Senator, but they are
going to send for him.
He spoke earlier in the day.
Mr. President, I do not need but just a few moments. I was not
privileged to hear Senator McCain and those who proffered this
amendment. But let me first say that whatever they said about the
status of the way we through the Federal Government are funding medical
doctors' education, both straight medical school and for specialties,
whatever they said about how egregious it is, they are probably right.
The point is that what they seek to do is not going to help a bit
because what has actually happened is that we are paying for medical
education out of the Medicare fund, and we have been doing it for a
long time. That is sort of a way for you to fund medical education, and
if nobody knows about it, it doesn't count very much because it is
coming out of what was always a very big trust fund. As a consequence,
medical education is costing a huge amount of money and the biggest
player--so everybody will understand this issue of who is going to
decide how many doctors we have, right now the biggest player is the
Federal Government. We are the ones putting huge amounts of money into
the teaching hospitals that permit them to teach as many doctors either
general medicine, their first years through, or their specialties.
Obviously, we are proud that that system has yielded the best doctors
in the world, I do not think there is any doubt about that, including
the best specialists in the world. But the cost is enormous, something
like $100,000 a doctor. And let me repeat, we, the taxpayers, through
this mechanism are paying for that. So in a sense we already are the
switch that is going to determine how many doctors we have and how many
we do not have. And now all of a sudden in the budget debates there is
a recognition that we cannot afford to spend as much as we have been
spending.
So the experts from the various committees and staffers--and I only
regret to say I am not on the committee with jurisdiction. I was there
negotiating with our distinguished leader, but the

[[Page S8967]]

conclusion was we have to save some money on this Federal expenditure
producing these doctors in particular since there are too many being
produced, at least more than we ought to be paying for. Maybe that is
the way I ought to say it. If they want to produce more and somebody
wants to pay more money, that is the marketplace, good luck. But we are
the marketplace substantially now, the taxpayers.
So nobody wants to cut the subsidy. The AMA does not want us to cut
the subsidy. The schools that are great schools do not want us to cut
the subsidy. So to save money somebody came up with an idea to start a
pilot project and see if in New York you said to the schools produce
less doctors, we give you less money, and of the money saved, you get
half and we get half.
As this budget worked its way through the Congress, through the
conference and debates, somebody said if you are going to try the pilot
in New York, try it all over the country. So what we have is language
in a budget deal that has already been voted in that says try this
everywhere in the country and see what we get out of it.

The end product, Mr. President and fellow Senators, is that the
Congressional Budget Office estimates we will spend $230 million less
this way than if we did not do it this way. So essentially, whether one
likes the idea or not, the alternatives are very simple. One, if you
take it out, as Senator McCain is recommending, you spend more money.
Could I have an additional minute, 2 minutes?
You do what Senator McCain is asking us to do and you spend $230
million more according to the Congressional Budget Office. I have no
reason to discount that information.
Mr. McCAIN. Mr. President, I ask unanimous consent that the Senator
from New Mexico be granted 5 additional minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DOMENICI. I thank the Senator.
So one option is to take it out and lose $230 million which the
budget process has not found anywhere, and Senator McCain and his
supporters are not finding anywhere. So it is essentially breaking the
budget by $230 million, which means when the time has all expired, I
will make a point of order that it violates the Budget Act and the
Senators can vote up or down do they want to violate the Budget Act or
not. If they do, we would lose $230 million, and that is their call
collectively, and we need 60 votes to do it.
One should ask, if the McCain amendment succeeds, where are we? The
interesting thing is if the McCain amendment passes, we are right back
to where we were before with the Federal subsidy program in place. We
haven't reduced it significantly--a little bit, but we are still in
there subsidizing just as we have been with a little bit less money.
What we really ought to do is decide how we are going to change this.
If we are putting too much money into the education of doctors at every
level including specialists, we ought to put less in, and that is what
we do not have the intestinal fortitude to do. And I guarantee you if a
committee that has jurisdiction came to the floor with a proposal that
said we are going to reduce the subsidy significantly so we don't spend
as much money, thus you teaching hospitals get less, there would be a
huge uproar and every Senator who has a major medical hospital and
educational institution that produces medical doctors will be here
talking--I see my friend from New York. He would be here certainly, and
so would Senator Moynihan--saying it is the end of the world, it is the
end of medicine as we know it. We did not do this.
I frankly believe in the long run we have to do it. We cannot have so
much capacity paid for by the Government. In the long run the private
sector can pay anything they want and families can pay if they want.
But the Federal Government to be the catalyst for producing more
doctors than anybody thinks we need is just kind of absurd.
So on the one hand I thank Senator McCain and his supporters for
bringing this issue to the Senate. And maybe, win or lose, he will have
prompted us to do something we ought to really do about this program,
and I submit it is not to do what we have done in the budget. I do not
have any alternative but to support it today and say, if we take that
out, we lose a substantial amount of money. Nonetheless, Senator McCain
and those supporting him will have had an educational exercise here and
I think I have contributed to it.
Mr. D'AMATO. May I make an inquiry?
Mr. DOMENICI. Sure.
Mr. D'AMATO. Did the Senator raise the point of order?
Mr. DOMENICI. No. I will when the time is up. You can't until the
time has expired. If I had any time----
The PRESIDING OFFICER. The Senator has 2 minutes remaining.
Mr. DOMENICI. The Senator wants to speak in opposition?
Mr. D'AMATO. Yes.
Mr. DOMENICI. I will give the Senator the remaining minutes.
The PRESIDING OFFICER. The Senator from New York is recognized for 2
minutes.
Mr. D'AMATO. Mr. President, I have heard the Senator from New Mexico,
and I agree with him. I also think that the Senator from Arizona does
us a great service by saying, look, this may not be the methodology,
the best method of paying for the training of our doctors, but, having
said that, that is the system that exists. The legislation that the
Senator's amendment would affect is designed, maybe imperfectly, to
begin to reduce those expenditures, those moneys that come out of the
Treasury.
Let me say this to you: It is not fair to say that we are paying for
doctors that are not going to be in training and, indeed, again, the
proposal that the administration has put forth and that the committee
has expanded that goes beyond New York and now nationwide, those
dollars will be used to provide adjustment assistance, because as these
hospitals downsize, they are going to have to hire additional staff
doctors, nurse practitioners, physician assistants and other personnel
to replace the residents who now treat Medicare patients.
So this is a canard to simply say we are giving you money not to
train doctors. It is transition and, in the fullness of time, will save
the taxpayers, depending upon who is doing the scoring, as much as $350
million. You can't knock a program on one hand and say you are paying
all this money and we should reduce it, and when you come up with a
methodology to reduce it then say, ``Oh, no, that's not the right
methodology.''
Show us a way in which you do that and don't throw the teaching
hospitals into chaos. This is the manner that I would suggest, as
imperfect as it may be, that the committee came up with. For those
reasons, I hope that we will refrain from piling on and supporting the
McCain amendment which does not help the situation.
The PRESIDING OFFICER. All time in opposition has expired. The
Senator from Arizona has 6 minutes remaining.
Mr. McCAIN. Mr. President, I will be glad to give 2 additional
minutes to the Senator from New York if he would like.
Mr. D'AMATO. Mr. President, I thank the Senator for his generosity. I
think I have made our point, but the Senator couldn't be more gracious
in providing us that opportunity.
Again, I do hope we can find a better way to fund this, because I
don't think people know that the Federal Government put so much money
into teacher training. If there is a better way to fund it and finance
it, I think we should look for that.
Mr. DOMENICI. Will the Senator yield me 30 seconds?
Mr. McCAIN. I yield 30 seconds to the Senator from New Mexico.
Mr. DOMENICI. I made a mistake, Mr. President, in giving you the
estimate of what this will cost the budget. I gave you $230 million.
The Congressional Budget Office has now looked at the whole country,
because this applies to the whole country, and their estimate now is,
so everyone will know, if the McCain amendment is adopted, the budget
will be, in the first 5 years, $390 million short. That is, that much
will be added to the deficit and, over 10 years, believe it or not, it
is $1.9 billion. I yield the floor.
Mr. McCAIN. Mr. President, how much time do I have remaining?
The PRESIDING OFFICER. The Senator from Arizona has 5 minutes 20
seconds remaining.

[[Page S8968]]

Mr. McCAIN. I yield myself 1 minute, and I will then yield the
Senator from Texas the remaining time.
Mr. President, the Senator from New Mexico asked where would we be if
my amendment is adopted? We would not be in the business of paying
people not to do things. We would not be, through central planning and
pure socialism, deciding what the supply of doctors in this country is
when there are 46 million Americans that do not receive health or
medical care in America today. That is an outrage and an insult.
We spend our time fighting on the floor of this Senate about
appropriating more money to take care of health care for kids, more
money to take care of health care for elderly Americans. How in the
world are we going to do that if we don't have enough doctors? The fact
is that the Senator from New Mexico asked where would we be? At least
we would not be in the bizarre and incredible situation where we are
paying schools not to do anything.
We tried this with the agriculture program, Mr. President. We tried
it before, paying people not to grow crops. It doesn't work. You don't
adjust people's behavior by doing such things and, believe me, this
amendment, this provision--I allow myself additional 30 seconds--I want
to point out again the process that this went through. Never a word of
debate on the floor of the U.S. Senate on the Balanced Budget Act. I
don't know what in the world this has to do with balancing the budget,
but what it had to do with was a provision that was stuck in on the
House side and, in less than 24 hours, we had to examine a 1,000 page
document which clearly nobody on this floor today, with the exception
of the Senator from New Mexico, had a chance to examine or debate. This
is not the right way to legislate. This is not the right way to conduct
our business in America.
I yield my remaining time to the Senator from Texas.
The PRESIDING OFFICER. The Senator from Texas is recognized for 3
minutes 30 seconds.
Mrs. HUTCHISON. Mr. President, I will just inform the Senator from
Arizona that I will be happy to yield back a minute of my time since he
so generously has given me the last time.
Mr. President, let me just say that I am a supporter of medical
education. I have supported every amendment that has come through here,
and I have sponsored amendments that add to the medical schools' part
of Medicare funding. I want medical schools to be funded. But, Mr.
President, this is not the way to do it. In fact, the University of
Texas, which is a school that has one of the best medical schools in
the whole United States, has said this is bogus, and they have refused
to take the extra funds in this way not to train medical doctors. They
are not in the business of not training medical doctors, and they have
refused this money because this is the wrong way to go.

Only in Washington would we address the issue of an oversupply of
doctors by funding not teaching doctors. Some would say, if this were a
debate to increase spending not to educate lawyers, maybe it would be
worthwhile. But, in fact, we are not going to do anything so silly as
to pay not to train doctors or lawyers or any other professionals in
this country. This is not the way to address the issue of oversupply.
The issue of oversupply is real.
The issue of training doctors is very important. In fact, I would
like to increase funding. I wish that we could substitute what we would
save here and put it into other parts of Medicare funding, perhaps
rural medical education, which is suffering greatly.
I believe in teaching hospitals. I do not believe in paying hospitals
not to teach, and I hope we can correct that inequity. I hope we can
legislate in a responsible way. I hope that we can put our money into
Medicare, into medical education, into training doctors, into rural
health care where we need the money, but I do not want to spend one
dime not to train doctors with added funds. It doesn't pass the smell
test, and I am proud to say that the University of Texas, from my home
State, is not taking these dollars because they believe this is bogus.
They need money to train doctors in the best way, but this is not the
best way.
Thank you, Mr. President, and I yield the floor.
The PRESIDING OFFICER. The Senator from Arizona has 30 seconds
remaining.
Mr. McCAIN. Mr. President, I just will comment that I was very
interested in hearing the statement of the Senator from Texas that
indeed there is a university in America that has decided they don't
need to be paid not to train doctors. Of course, I put a further
credibility test on this argument that somehow teaching hospitals
across America have to have this huge subsidy not to train doctors. I
hope more schools and universities will follow the example of the
University of Texas.
The PRESIDING OFFICER. All time has expired on amendment No. 1091.
The Senator from New Mexico.
Mr. DOMENICI. Mr. President, can I have 10 seconds before I make my
motion? I, too, hope all the hospitals do that. If they do, we will
save $390 million and over 10 years we will save $1.9 billion. I think
that would be an exciting end product.
Mr. President, the McCain amendment increases mandatory spending and
is scored against the subcommittee's allocation. This additional
spending would cause the underlying bill to exceed the subcommittee's
allocation. Therefore, I raise a point of order against the amendment
pursuant to section 302(f) of the Budget Act.

Motion to Waive the Budget Act

Mr. McCAIN. Mr. President, I move to waive the budget point of order
pursuant to section 904 of the Budget Act, and I ask for the yeas and
nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The yeas and nays were ordered.
Mr. McCAIN. Mr. President, I ask unanimous consent that the yeas and
nays be delayed until the managers of the bill decide the most
appropriate time. There are important hearings going on at this time,
and I don't think that they wish to have it interrupted. So I ask
unanimous consent that, pending the decision of the managers of the
bill and the leaders, that the yeas and nays be set aside.
The PRESIDING OFFICER. Without objection, it is so ordered.
Under the previous agreement, there is now 20 minutes equally divided
on the issue to waive the Budget Act. The Senator from Arizona.
Mr. McCAIN. Mr. President, I yield back my time.
Mr. DOMENICI. I yield back any time I have on the motion.
The PRESIDING OFFICER. All time has been yielded back then on the
motion to waive the budget point of order.
Mr. DOMENICI. Have the yeas and nays been ordered on the motion?
The PRESIDING OFFICER. Yes, they have.
Mr. McCAIN. Mr. President, I am astounded and very pleased to note
that the FY 1998 Labor/HHS appropriations bill is nearly devoid of any
pork-barrel language, at least in the bill itself. After careful
scrutiny of the measure, I have found only one section of the bill
which is clearly pork. That is section 506, which contains the language
on Buy America set-asides that appears to be standard practice in this
year's appropriations bills.
Other than these Buy America provisions, which I continue to
strenuously oppose, I can find no other egregious examples of pork-
barrel spending in the bill language. For this restraint, I thank the
subcommittee chairman, Senator Specter, and the members of the
Appropriations Committee.
Unfortunately, the report does contain a number of earmarks of funds
for location-specific, unauthorized, or simply wasteful projects. And
it contains, of course, language that is intended to have essentially
the same effect as an earmark; by this, I mean the use of words like
``encourage'', ``urge'', and ``carefully consider'' in connection with
references to particular institutions, projects, or proposals that the
committee would obviously like the relevant agencies to fund. These are
not earmarks, but I am sure the programs which the committee encourages
or urges the agencies to support will receive special consideration.
I would like to submit for the Record the full list of objectionable
provisions in the bill and report, but would take a few moments of the
Senate's time to note just a few of the more interesting earmarks in
the bill:
Report language directs OSHA not to enforce methylene chloride
regulations

[[Page S8969]]

because small employers in the furniture stripping and foam
manufacturing and fabrication industries are concerned about the cost
of compliance.
The report earmarks $326,000 for the Central Montana Head Start
Program to secure donations of surplus property.
The report earmarks $1 million for the Very Special Arts Festival in
Los Angeles.
The report earmarks $500,000 for the native Hawaiian education
council and island councils.
As I noted, the report language contains a multitude of expressions
of support, short of earmarks, for particular projects. A few examples:
Encourages the Department of Labor to expedite consideration of a
request by the Iacocca Institute for funding to create a work force
development education curricula.
Encourages full and fair consideration of proposals by the Cabot
Westside Clinic and Samuel U. Rodgers Health Center in Kansas City, MO.
Urges consideration of a proposal by the North Dakota State College
of Science in Wahpeton, ND, to conduct a consolidation of instructional
facilities for allied health programs into one site in a rural area.
Urges the Centers for Disease Control to work with native Hawaiians
to explore whether utilizing indigenous Hawaiian healing methods may
impact the incidences of diabetes and asthma.
Encourages consideration of a proposal to establish a dedicated Human
Islet Processing and Distribution Center by the Miami VA Medical
Center, Jackson Memorial Hospital, and the University of Miami Diabetes
Research Institute.
Urges National Institutes of Environmental Health Sciences to study
the health aspects of volcanic emissions.
Urges NIA to consider providing assistance to the West Virginia
University's Year 2000 International Conference on Rural Aging.
Urges full consideration of a proposal by the Birmingham Alliance for
the Mentally Ill Crisis Intervention Task Force in Jefferson County,
AL.
Urges consideration of a proposal by the Institute for Responsible
Fatherhood and Family Revitalization in Cleveland, OH, to replicate its
program, and sets aside $300,000 for this project.
Urges consideration of a proposal from the Women's Institute for a
Secure Retirement for pension counseling.
Urges $800,000 to be provided to assist in cataloging and preserving
Pennsylvania's library of anthracite coal region.
Urges the Department of Education to provide $27 million in funding
to 18 different colleges and universities for unspecified purposes.
Again, this report contains far fewer earmarks than any other
appropriations report considered by the Senate this year. By my count,
the total of the report language earmarks is approximately $35 million.
Compared to the more than $10 billion in pork-barrel spending in the 10
previously approved bills, this is not a large sum.
But the problem with pork-barreling is that the average American does
think that $35 million is a large sum. In fact, most Americans think
that $35 million is quite a lot of money. I certainly do.
And the fact is that this is $35 million that was taken from the
American people in the form of taxes. And now we, the representatives
of the people, are earmarking these funds for special interest projects
that do not necessarily reflect the needs or priorities of all or even
a majority of the American people.
Mr. President, that is why pork-barrel spending is wrong. And that is
part of the reason the American people hold the Congress is such low
regard.
Again, my thanks to Senator Specter for exhibiting remarkable
restraint in the spending priorities in this bill. I hope others will
take his example to heart as we prepare to consider conference reports
on the fiscal year 1998 appropriations measures.
I ask unanimous consent that a list of objectionable provisions in
the bill be printed in the Record.
There being no objection, the list was ordered to be printed in the
Record, as follows:

Objectionable Provisions in the Fiscal Year 1998 Labor-HHS
Appropriations Bill and Report

Bill Language

Section 506. Buy-America provisions (contained in almost
all appropriations measures this year)

Report Language

Earmarks

$1 million for a manufacturing technology training
demonstration project in Mississippi which will educate
technically competent new entrants into the work force and
retrain the existing work force to adapt to technological
innovation.
Funding for consideration for a multi-State implementation
of models, such as the New Mexico Retail Association's
Program for youth opportunities in retailing.
$3 million for the Samoan/Asian Pacific Island job training
program in Hawaii.
$200,000 to the Vermont Department of Employment and
Training to aid in the development of a high skills training
consortia and a pilot project to begin training in targeted
areas.
Language directing OSHA not to enforce methylene chloride
regulations (except in certain circumstances) because small
employers in the furniture stripping and foam manufacturing
and fabrication industries are concerned about the cost of
compliance and the assurance of the availability of OSHA
compliance assistance.
$3.5 million for the Native Hawaiian Health Care Program.
$1.75 million to Hawaii for medical care for Hansen's
disease patients in the State. The Committee has provided
funding for the payment to Hawaii as a separate line item
rather than part of the overall appropriations for Hansen's
disease.
$2.045 million for the State of Hawaii for medical care and
treatment in its hospital and clinic facilities ($295,000
above the administration request).
Funding for a community based intervention project for
diabetes prevention in Gallup, New Mexico.
Funding to assist in the conversion of the Savannah River
site cancer registry and the South Carolina State cancer
registry into a single statewide registry.
Language noting that Alaska be treated favorably in the
allocation of the increase provided for substance abuse
centers.
Funding for a three year extension for the Temple
University Hospital Ventilator Rehabilitation Unit.
Funding to continue the existing grant to the National
Indian Council on Aging that increases Indian elder awareness
and participation in the public policy issues that have
direct impact on all of the Indian country.
$326,000 for the Central Montana Head Start Program to
secure donations of surplus property.
$1 million for a Charlotte-Mecklenburg schools
prekindergarten initiative for startup costs and renovations.
Language stating that priority should be placed on
supporting projects such as the House of Mercy in Des Moines,
Iowa to promote self sufficient and independent living for
runaway and homeless youth.
$130,000 should be made available to colleges and
universities that have enrolled American Indian and/or Alaska
Natives in masters degree programs in social work.
$260,000 for the National Asian Pacific Center on Aging to
link the Asian Pacific aging community with other services
and organizations.
An increase to the North Philadelphia Cancer Awareness and
Prevention Program.
$1.4 million (unrequested) for the Bethune Memorial Fine
Arts Center in Florida.
$4.25 million grant to the John F. Kennedy Center for the
Performing Arts.
$1 million for the Very Special Arts Festival in Los
Angeles, CA.
$500,000 for the University of Hawaii Center on the Family.
$500,000 for research on technology to be used by children
with disabilities. The Committee believes that the University
of Northern Iowa would be best suited to do this research.
$1.5 million for the Readline Program. The Committee notes
that the Greater Washington Educational Telecommunications
Association is well-suited to handle this research.
$4.2 million for the Hawaiian higher education program.
$500,000 for the University of Hawaii at Hilo Native
Languages College.
$500,000 for the Native Hawaiian education council and
island councils.
$7.1 million for family-based education centers.

Words of encouragement and support

Encourages support from discretionary funds, to the Kauai
Cooperative Extension Service to train dislocated sugarcane
workers.
Requests that the Secretary consider funding for next
fiscal year for at risk youth in Rhode Island and Delaware.
Encourages the Department to expedite consideration of a
request by the Iacocca Institute for funding to create a work
force development education curricula.
Urges full and fair consideration of a proposal by the
Eisenhower Foundation to employ welfare recipients in high
tech industries.
Recommends funding for a native Hawaiian initiative which
provides tutoring for high risk youth residing in rural
communities.
Urges that $5 million be provided in Job Training
Partnership Act to be used for adults in Hawaii and Alaska
Community Colleges.

[[Page S8970]]

Encourages full and fair consideration of proposals by the
Cabot Westside Clinic and Samuel U. Rodgers Health Center in
Kansas City, MO.
Encourages utilization of the expertise and resources of
the universities in the Pacific region in providing training,
technical assistance and program evaluation in Hawaii to
address the health needs of Hawaii's underserved.
Encourages full and fair consideration of a proposal to
provide rural clinical experiences to eligible residents of
the States of Washington, Alaska, Montana, and Idaho.
Encourages full and fair consideration of a proposal by the
Connecticut Children's Medical Center.
Encourages full and fair consideration of a proposal by the
University of South Alabama to initiate the Southwest Alabama
Network for Education and Telemedicine.
Urges consideration of a proposal by the State of Vermont
to conduct a telemedicine demonstration project.
Urges the HRSA to focus attention on the shortage of
emergency and medical services for children in Alaska and
Hawaii.
Urges support for the efforts of the National Organization
of Concerned Black Men, Inc. Of Philadelphia, PA to enhance
the involvement of African American men in family planning,
pregnancy prevention, parenting skills and fatherhood
responsibility.
Urges consideration of a proposal by the McLaughlin
Research Institute of Great Falls, MT to undertake biomedical
research.
Urges consideration of a proposal by the North Dakota State
College of Science in Wahpeton, ND to conduct a consolidation
of instructional facilities for allied health programs into
one site in a rural area.
Urges expeditious consideration of a proposal by the
Carolinas Health Care System of North Carolina to establish
the Carolinas Community Health Institute.
Urges consideration of a proposal by the Sacred Heart
Hospital in Allentown, PA to optimize the delivery of health
care services to the underserved in the region.
Urges consideration of a proposal by the Lehigh Valley
(Pennsylvania) Hospital and Health Network's effort to
construct a center which provides geriatric care, adolescent
health services and general prevention services.
Urges consideration of a proposal by the Associates in
Medicine Program at Columbia University in New York City to
provide medical care to inner-city neighborhoods.
Urges strong consideration of a proposal by the University
of Alabama at Birmingham for construction of an outpatient
facilities at a genetic counseling, patient care, and
research center.
Encourages consideration of support for research by the
Thomas Jefferson University Center for Biomedical Research in
collaboration with the Delaware Valley College involving
research on plant-delivered oral vaccines.
Urges careful consideration to a one-time reprogramming
request from funds provided for immunization activities that
would allow construction of a new infectious disease
laboratory project.
Urges the CDC to work with Native Hawaiians to explore
whether utilizing indigenous Hawaiian healing methods may
impact the incidences of diabetes and asthma.
Encourages the CDC to work with NINR and NIEHS to determine
the environmental, physical, and mental effects of volcanic
emissions in Hawaii.
Encourages the CDC to support MALAMA, a partnership program
which addresses the prenatal needs of minorities in rural
Hawaii.
Encourages the CDC to support an extension of a project at
the University of New Mexico involving fetal alcohol
syndrome.
Encourages the Director of the CDC to consider supporting
the efforts by Newark, NJ to combat teen pregnancy, low birth
weight babies, and infant mortality.
Encourages continued research in the area of cancer in
minorities such as that done at the Hawaii Cancer Center.
Encourages the NIDDK to develop a targeted diabetes
prevention and treatment program and encourages the CDC to
work with native American, native Hawaiian and native Alaskan
groups for this program.
Encourages consideration of a proposal to establish a
dedicated Human Islet Processing and Distribution Center by
the Miami VA Medical Center, Jackson Memorial Hospital, and
the University of Miami Diabetes Research Institute.
Encourages the creation of a position for a senior program
officer with specific responsibility for the coordination of
the NIH-wide Parkinson's research program.
Encourages the NIAID to continue working with the Jeffrey
Modell Foundation on both research and public education
endeavors.
Encourages the NIAID to give consideration to research
conducted at the Public Health Research Institute on
infectious diseases.
Encourages the NICHD to give consideration to projects to
create community-based centers designed to strengthen
families in multi cultural environments.
Urges the NIEHS to continue to collaborate with NINR to
study the health aspects of volcanic emissions in Hawaii.
Recommends the advancement of establishing a center
focusing on natural marine toxins. Notes the unique work
being done at a Miami NIEHS center.
Urges the NIA to consider providing assistance to the West
Virginia University's Center on Aging' year 2000
International Conference on Rural Aging.
Encourages the NIA to work with organizations such as the
National Asian Pacific Center on Aging to provide for the
underserved and isolated senior groups.
Encourages the NINR to ensure that research efforts extend
to the health care needs of racial and ethnic populations,
such as, native Hawaiians.
Encourages NIDA to work with existing native American
organizations to increase the effectiveness of sobriety
programs.
Encourages the National Institute of Mental Health to
initiate a workshop and consider supporting an additional
service delivery research center to eliminate the stigma
associated with seeking mental health services in rural
areas.
Strongly urges the NIH to consider a proposal from the
University of Colorado Health Sciences Center regarding the
collocation of the cancer center research and clinical
facilities in Aurora, CO.
Encourages consideration be given to support the Florida
based Batchelor Children's Research Center to develop a
children's biomedical facility in Miami.
Urges consideration of a proposal by the School of Pharmacy
at the University of Montana.
Requests that the National Center for Research Resources
recognize the University of Alaska as a minority school for
the purposes of qualifying for support under its Research
Centers in Minority Institutions Program.
Requests that consideration be given to a request for
Federal funds by the Children's Hospital and Medical Center
of Seattle for its large medical laboratory equipment needs.
Encourages consideration be given to providing funding for
the University of Miami's International Center for Health
Research's work on diseases transported from air travelers
and migration from Latin America and the Caribbean.
Encourages the Director of the NIH to give consideration to
a proposal by the Seattle Indian Health Board's American
Indian Family Practice Residency Program. This involves a 3-
year program that recruits and trains family practice
physicians into service to American Indian and Native Alaskan
populations.
Urges full consideration of a proposal by the Birmingham
Alliance for the Mentally Ill Crisis Intervention Task Force
of Jefferson County, AL.
Urges the funding of training projects that foster cultural
competencies, a diverse work force, collaboration
among disciplines, and that promote the use on
interdisciplinary service delivery models especially in
rural areas such as Hawaii.
Urges consideration of a proposal by St. Louis 2004, a
group located in St. Louis MO, to provide expanded coverage
to uninsured individuals.
Urges consideration of a proposal by the National Asian
Pacific Center on Aging to increase Indian elder awareness.
Recommends that HCFA provide additional funds for a
demonstration project to address the access, delivery system,
and financing issues related to predual eligible and dual
eligible minority adults.
Urges consideration of a proposal by the Wills Eye Hospital
in Philadelphia to establish a demonstration project in
opthamology.
Language encouraging the Administration for Children and
Families to develop a demonstration project to evaluate the
effectiveness of a family-centered model for the treatment of
child-sexual abuse like the one operated in Louisville, KY.
Urges consideration of proposal by the Institute for
Responsible Fatherhood and Family Revitalization in Cleveland
to replicate its program, and sets aside $300,000 for this
purpose.
Encourages the use of $350,000 for the Alaska Federation of
Natives to conduct a study an further approaches to implement
recommendations of the Alaska Natives Commission.
Urges the native Hawaiian grantee to coordinate with the
Lunalilo Home in Hawaii regarding the continuing to tailor
nutrition services that are appropriate to the circumstances
associated with the served population.
Urges consideration to a proposal from the Women's
Institute for a Secure Retirement for pension counseling.
Urges the Secretary on Aging to provide $350,000 for each
of the national resource centers serving native American
elders in fiscal year 1998.
Encourages full consideration of support by the Office of
Public Health and Science for a partnership between the
University of Miami and Florida State University.
Encourages assistance in the planning of a new children's
hospital in the Bronx.
Encourages sustaining a demonstration project at the
Meharry Medical College of Nashville, TN.
Urges that consideration be given in the awarding of
technology grants to school districts such as the Houston
Independent School District.
Requests reconsideration of the determination that three
school districts, which previously received too much federal
aid, must pay it back to the Department of Education. Two in
Texas and one in New Jersey.
Requests better funding for the Centennial School District
in Warminster, PA.
Urges the Dept. Of Education to work to rectify a problem
that the Portsmouth School District in Rhode Island is having
with attaining impact aid payments.
Urges the Department to initiate discussions on a new
facility for the Fort Belknap Reservation in north central
Montana.

[[Page S8971]]

Asks the Department of Education to approve a grant
application by the Seattle School District for funding under
the Magnet Schools Assistance Program.
Urges the Dept. Of Education to provide $500,000 for
workshops in aquaculture/education for high school students
and teachers in Hawaii.
Favors the expansion of Native Hawaiian agriculture
partnerships and stresses that the Hawaii Institute of
Tropical Agriculture and Human Resources is especially suited
to assist in the expansion of this program.
Urges that assistance should be made available for a
partnership between Partners in Development (a Hawaii
nonprofit corporation) and an appropriate nonprofit
organization with expertise in sustainable waste treatment
methods.
Urges the Dept. Of Education to provide $1.8 million for
children with disabilities, particularly in the Mississippi
River Delta.
Urges the Department to provide $1 million to support
assisted living programs at The Good Shepherd Rehabilitation
Hospital in Lehigh County, PA.
Urges the Department to use $1.5 million for a
demonstration program to develop work force skills for audio
visual communications. The Educational Communications
Foundation should carry out this project.
Urges the Dept to provide $1 million for a competition
among post secondary institutions. Pennsylvania Institute of
Technology would be well suited to administer such a
competition.
Urges the director of the Institute of Museum and Library
Services to provide $1 million for an Internet demonstration
project to be done by the University of Montana and Montana
State University.
Urges $1 million for a digitalized card catalog for the New
York Public Library.
Urges funds be provided for museums in Philadelphia,
Baltimore, and Boston. The Committee urges $4 million for
such programs.
Urges $800,000 be provided to assist in cataloging and
preserving Pennsylvania's library of anthracite coal region.
Urges the Social Security Administration of North Carolina
to maintain a physical presence in the office in Statesville,
NC for a minimum of 2 days.
Urges the Department of Education to provide the following:
$1 million to Prairie View A&M University in Texas for
incoming college freshmen who are at risk of not finishing
college.
$1 million to The Vermont Science and Education Center in
St. Albans, VT.
$2 million to the Community College in Onslow County, NC
and the University of North Carolina at Wilmington.
$2 million for the Empire State College in New York and
Rutgers University in New Jersey.
$180,000 to North Dakota State University.
$1 million to a consortium of Kansas universities.
$1 million to Bryant College in Smithfield, RI.
$300,000 for the University of New Mexico.
$2 million to Missouri State University.
$500,000 to the Advanced Technical Center in Mexico, MO.
$2 million to the Pennsylvania Telecommunications Exchange
Network.
$1 million for a joint venture between the Newport News
Public Schools System and the city of Newport News.
$1 million to the University of Pennsylvania.
$1 million for science enrichment for 9th and 10th grade
minority girls.
$3 million to several Iowa school districts.
$5 million for the State of Washington Office of the
Superintendent of Public Instruction.
$2 million for the Pennsylvania Consortium for Higher
Education.
$1 million to the National Science Center Foundation in
Augusta, GA.

Mr. BOND addressed the Chair.
The PRESIDING OFFICER. The Senator from Missouri.

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