sion in which a reauthorization bill was introduced. Although the details may vary, it is likely that the themes that prevailed in political discussions around funding for biomedical research during the 104th Congress will predominate in the foreseeable future.
NIH was founded in 1930. It moved to Bethesda, Maryland, in 1938 as extramural funding of medical research began to expand. With the onset of World War II the urgency and magnitude of the health needs of American troops gave modern biomedical research its seminal boost. NIH produced the first extramural contracts to universities, research institutions, and hospitals (Starr, 1982).
The momentum in biomedical research did not end with the war. Consistent growth of federal support for NIH continued at a remarkable pace in the half-century after the war. During that period NIH funding doubled every 5 years (Varmus, 1995).
This momentum cannot be sustained into the next century because of two pressures on research funding. First, expanding federal entitlements have reached a level that creates pressures that limit growth of the discretionary portion of the federal budget. Support for NIH is part of that discretionary budget. Second, the constant erosion of purchasing power brought about by inflation is unremitting.
Mandatory spending in the federal budget—so-called entitlements—increasingly drives the budgetary process. Entitlements constitute that portion of federal spending that obligates the payment of benefits to anyone who meets explicit eligibility requirements established by law. Examples of entitlements include Social Security, Medicare, and Medicaid. In 1995, mandatory spending constituted 65 percent of the federal budget. This left little wriggle room in the discretionary budget, which is only 17 percent of the total federal budget (Rimkunas, 1994). Unmodified, mandatory spending will increasingly encroach on domestic discretionary spending.