Supercommittee Failure Hurts Public Health
The outlook may be quite grim for our nation’s already hobbled public health system. The budget of the Centers for Disease Control and Prevention is one of the better examples of what the debate in Washington is doing to programs the public generally see as important. It also shows us what automatic cuts - or sequestration - could do to further erode the nation’s disease control and prevention infrastructure.
The CDC's Budget, FY '05 to FY '12
In the news, of course, is the fact that Congresses bipartisan supercommittee has failed to negotiate some combination of budget cuts and revenue sources to cover a ten-year trillion-dollar deficit reduction package. Now sequestration is set to kick in: an automatic backup plan set in place by Congress 6 months ago that will automatically and indiscriminately cut $1.2 trillion in ten years, beginning in 2013.
Sequesters are unattractive legislative tools because they are the mindless ax of budget cutting, not an intentional legislative scalpel. By failing, Congress and the committee is giving up on thoughtful legislation in favor of blind across the board cuts. Sure, Congress could try to tinker with the sequestration law they past earlier this year between now and 2013, but partisanship leading up to the pending elections and the risk of destabilizing world markets even more both stand in the way of such an idea.
Advocacy Groups at Work, But What Now?
When a free kick is taken in soccer, defenders line up shoulder to shoulder between the kicker and the goal and assume the same position: each stands in the way of the ball and protects their privates. Here in Washington, with major cuts on the horizon, nearly every interest group in Washington has lined up and is assuming this defensive position, doing all they can to keep Congress from kicking their funding into the deficit reduction goal.
Earlier this year, public health groups weighed in with supercommittee members when prevention funding was in danger - and they were able to make their case. Now, with sequestration, there may be little body politic to approach. The disease control and health protection efforts managed out of agencies like the CDC will be on the chopping block while federal spending on Medicare and other programs to treat those sickened by preventable illness will grow or see only minimal decreases. By all measures, the public disagrees.
Regardless of party lines and political ideologies, Americans generally agree that it is better, cost-wise and health-wise, to prevent illness.
In 2009, the Robert Wood Johnson Foundation and Trust for America’ Health found that 71 percent of Americans favor increased investments in disease prevention. Similarly, a Research!America poll from this June showed that 80 percent of Tea Party supporters expressed a favorable impression of the Centers for Disease Control and Prevention. A separate poll conducted by Research!America in March 2011 found that 83 percent of the public believes increased funding for the CDC is important.
Even with good polling numbers, prevention gets scant attention from policy makers. This is due in part to the fact that preventing disease accounts for a tiny part of overall federal health spending. Considering we spend 70 percent of our health dollar to treat preventable illness and disease, it is a bit shocking to realize that the entire budget of the CDC is only 0.4 percent of federal health spending. When compared to total federal spending, CDC’s share of the overall budget looks like a hairline crack on a pie chart. And over the past two years, that crack has been shrinking.
As our chart above shows, Washington’s support for disease control and prevention is dropping. Other key points illustrated here: CDC funding had already failed to keep pace with inflation between 2005 and 2010; CDC’s budget authority (the base funding shown in blue) was cut by 12 percent in FY11; and there remains a massive billion-dollar gap between the House Republicans and Senate Democrats regarding the CDC’s ideal budget for this FY12 fiscal year. With an agency whose core discretionary budget is under $7 billion dollars, that’s called not seeing eye-to-eye.
Why Sequestration will hurt Public Health
If there are no changes between now and FY 2013, federal "discretionary" spending for disease control efforts will be cut. An analysis done by the Bipartisan Policy Center estimates that sequestration will mean 10 percent cuts to defense spending, 7.8 percent cuts to non-defense discretionary spending and 2 percent cuts to Medicare – all beginning in fiscal year 2013.
[Watch our budget overview video if you don't know these terms.]
Today, some members of Congress have already said defense spending cuts under sequestration are too high and warn that these numbers will need to be adjusted. Lowering the percentage taken from defense would add pressure to further cut non defense discretionary areas of the budget like the CDC, NIH and FDA, for example.
At nearly every public health policy discussions I’ve participated in over the past decade, someone in the room almost always makes the same frustration-laden point: You don’t see the work of public health because good systems cause "nothing" to happen.
You aren’t the only one who has never called your local health department just to say, "Hey, thanks for all you did last year to prevent whatever injuries, illnesses and diseases would have occurred if you weren’t working to prevent them." [On that note, did you know today is Public Health Thank You Day?]
At times, we all pay attention. A flu or measles outbreak, news about a string of related food poisonings, a natural or man-made disaster, and even a popular movie about a spreading disease or infection can get the public’s attention of many for a period of time. Even a zombie blog post can reach millions.
Still, most public health efforts help the population as a whole and we are often totally unaware of the infrastructure keeping bad bugs out of our lives. Few individuals know how they benefited directly from controlling disease outbreaks, lowering obesity rates or ensuring that fewer children died in car crashes each year. Members of Congress, therefore, are not likely to hear from any of the 70 to 80 percent of American’s who say they would increase spending on disease control efforts.
Sequestration stands to blindly open the door to further degrade the already small amount of funding directed at keeping American’s healthy in the first place. The failure of Congress and the supercommittee puts deeper cuts to public health squarely on the table.
Moving forward, this blog will work to keep our eye on the work of disease control and prevention efforts. We hope you will lend us your support, ideas and input as we do so.
Karl Moeller, Executive Director
The photo above was taken in Washington’s Metro system. This is one of several ads in a series by the same group that blanket the entrance of the Metro station closest to the United States Senate. The ads ask Congress not to cut Medicaid, Medicare or access to post-acute and nursing home care. Ads supporting investments in preventing the need for post-acute care in the first place were nowhere to be seen.
