Extended Interview: Senator Daniel P. Moynihan
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SUSAN DENTZER: You said earlier that, as a child, you had benefited from the existence of this institution. Did you have a specific experience with Columbia Presbyterian at that time or were you speaking in more general terms that, you benefited because of the type of research and clinical care that was taking place there?
SENATOR MOYNIHAN: I remember one night about–I’m about nine years old and suffering awful pains in my stomach and I can’t know what to do and I’m hurting and howling and my mother just gets me into a taxicab and takes me here. And I don’t know what the matter was, but it was soon settled. This is where you went.
And incidentally, the idea of the bill, they didn’t send any bills. This was New York and this was its great institution.
SUSAN DENTZER: So, the care was free or your mother paid on the…
SENATOR MOYNIHAN: Well, it better had been free because we couldn’t have paid any bills as far as I know.
SUSAN DENTZER: Let’s move forward a bit to the present. As you suggested, there is this concern, widespread concern now that many of the changes that have taken care in the Medicare program specifically over the last several years, as a consequence of the Balanced Budget Act of 1997, put particular pressure on these institutions.
Do you think the Congress broadly understood what it was doing when it passed the Balanced Budget Act, particularly what the pressures would be on institutions such as this one?
SENATOR MOYNIHAN: Congress did not know what it was doing. It was just finding numbers to bring about a balanced budget, when we’re in fact on the verge of that–in any event, we have a surplus now, but we still have in place cuts in the provisions for teaching hospitals and medical schools that are ruinous.
Never should have been enacted; never should have been signed into law. Should be repealed, changed and with a measure of energy, because we are putting our health at risk in a way that you would never do to an individual, but we find ourselves doing to institutions. We are crisis. You’d better wake up.
SUSAN DENTZER: If I’m not mistaken, you were among those who voted for the BBA.
SENATOR MOYNIHAN: Yeah, yep and found out fast what I voted for. And we were able to change the provisions in the last go-round for the fiscal year just completed, but we have to do it again.
I think perhaps we will because, among other things, the medical schools are aware of this and are organizing and have wonderful plans of asking staffers in the Congress, staff people, young men and women, to come down to chapel–I mean, come down to one of the local medical schools. Every state has one or almost every state and spend a few days with the interns and make the rounds and see what goes on and get a sense of, oh, this is different. This is not just health care. This is the training of the next generation of doctors and nurses.
SUSAN DENTZER: Again, is that something that you think is understood broadly in Congress; that these institutions bring together this strange collection of education, research, clinical care all in one setting?
SENATOR MOYNIHAN: The important fact is that the medical schools, all of a sudden, have realized that this is not understood in Congress. If it were, we wouldn’t be in the mounting crisis that we are in. And they are undertaking to teach. That’s what they do, after all, to teach us through our staff.
That will work in time. I would wish there was more energy in the Executive. Now, we have the Health Care Financing Administration, HCFA. It sounds like a slight ailment–which is well run, but does not look to policies of this kind.
The Office of Management and Budget, well run, but it doesn’t think in these terms. And curiously, the National Institutes of Health get more money all the time, but just keep themselves narrowly focused on research subjects and not on the researchers. We can sort this out, but we have not done it.
SUSAN DENTZER: Now, to play devil’s advocate here, you have said in Congress for many years and many people have come before you and complained that they are at the mercy of cutbacks in federal funding, that their quality is being compromised. Quality is the word that health care providers throw out with abandon when they face financial pressures of any sort.
How is it that we really know that these institutions are doing everything that they can to be as efficient as possible? How is it that we know that they necessarily warrant the kinds of assistance that you are proposing to give them?
SENATOR MOYNIHAN: Well, we don’t know, but we dare not take the risk of being wrong. And these are, after all, universities. These are teachers. These are people that give their lives to research. They are healers. This is not the NASDAQ. These are people who devote their lives to the science of helping human beings who need their help. And the results are so extraordinary.
SUSAN DENTZER: Yet, everyone who has come close to an academic health center understands, as you certainly understood from your years in academia the phenomenon of medical school departments forming fiefdoms that remain long after the medicine, the validity of the medicine has passed.
Is it not necessary from time to time to give such institutions a shock to the system by essentially the public trough being, if not turned off, tuned down a bit?
SENATOR MOYNIHAN: Are you suggesting that doctors are human beings; that they don’t get special interests and defend them and protect them at their sense of what the right thing to do is? Of course, they do.
But what is the large outcome? Magnificent medicine in our age, the first time in the experience of the species.
SUSAN DENTZER: So, you’re saying in effect, sense we don’t really have a way of deciding what is absolutely necessary that go on in an academic health center versus what is turf-building or fiefdom-building, we should simply step back and say, here’s some money. We support the general thrust of this enterprise. Go ahead and do what you will for the advancement of civilization.
SENATOR MOYNIHAN: Well, that’s what you have deans for, you know, and visiting committees and all the structure that looks after the operations of a large hospital, a teaching institution. They’re effective. Are they perfect? No. Are they very good? Yes.
SUSAN DENTZER: You have introduced or sponsored the Teaching Hospital Preservation Act, which we spoke of a moment ago.
SENATOR MOYNIHAN: Um-hum.
SUSAN DENTZER: There are also efforts in Congress to continue to redress the cuts in BBA, to build on the Balanced Budget Refinement Act of last year.
What do you think the prospects are for Congress doing something about this…
SENATOR MOYNIHAN: They are good, because we have broken out of that terrible decade and a half of deficits, which were brought about as a political strategy actually. If there was no money, we wouldn’t spend it, would we? Well, we spent it anyway and it was a big slog.
I mean, I have been 24 years on the Finance Committee and we–my [unintelligible] just get into the situation and we’re out of it. And so, the iron–the just fiscal fact of not having the resources is behind us. Now, we have to make the policy decision about how to allocate public funds or how to raise them through simple tax measures. We could do that, if we would just pay a little attention to the subject. We’re beginning to, thanks very much to the medical schools saying, oh, I see. We have to go down and tell those folk what we do and how we do it.