Budget battle puts health spending in spotlight
Medicare and medical research remain top priorities for lawmakers - but with potential limits in view.
At the vast National Institutes of Health complex in Bethesda, Md., scientists are cracking genetic codes for "all the potential bioterror threats." They're starting the first human trials for a vaccine for the Ebola virus and closing in on a new vaccine for smallpox that has "virtually no adverse events."
But they're also funding Bo Vine, a pert and peppy Holstein who headlines the "Milk Matters" Internet game, and a $1.2 million panda study in a nation that has no native pandas.
For self-styled "waste watchers" in Congress, the NIH's budget line - which has more than doubled in the past seven years - is a tempting target for cutbacks, especially in a year when Congress expects one of the largest deficits ever.
"The NIH does great work, but they still need to be accountable to the American taxpayers," says Rep. Jeb Hensarling (R) of Texas, who sees a tough fight on spending in this week's House budget debate.
The NIH is far from the only agency facing new fiscal scrutiny, but such comments are a sign of emerging tension over an area of government spending that has grown so rapidly for four decades that it cannot be avoided when Congress focuses on new spending restraint. Medicare costs have soared from $64 million in 1966, when the program was launched, to an estimated $422 billion in the 2009 fiscal year. A new report by the Social Security/Medicare trustees today is expected to project those costs significantly higher, due to revised 10-year estimates of the cost of the $395 billion prescription drug plan that Congress added to Medicare last year.
Those estimates of growth in entitlement spending put even more pressure on the discretionary side of the budget - including even NIH. No group, short of the Pentagon in wartime, has been as successful as protecting its budget lines on Capitol Hill as NIH. In response to a powerful lobbying effort by the scientific community and disease-focused advocacy groups, President Clinton and the GOP Congress committed to doubling NIH funding in five years, beginning in 1998 - a budget surplus year. NIH funding has increased more than 107 percent since then.
The growth coincides with healthcare's rising role in the nation's economic life - fast moving toward one-fifth of GDP.
"It all comes down to our concern for health. Since the mid-'80s, numerous groups outside the science community and the disease groups have lobbied quite strongly for increases in health funding," says Kei Koizumi, head of the R&D budget and policy program for the American Association for the Advancement of Science.
But amid record deficits and a new scrutiny of by lawmakers, President Bush requested $28.6 billion for NIH in the 2005 fiscal year, a 2.7 percent rise over the previous year.
"We knew there would be a landing after doubling NIH budgets, but we had hoped for a softer landing. To go from 15 percent increase to 3 percent is not a very soft landing," says Joanne Carney, director of the Center for Science, Technology, and Congress for the American Association for the Advancement of Science.
One sign of trouble to come is the resurgence of criticism over particular NIH studies, especially those dealing with sexuality or stem cell research. Analysts say they haven't seen this kind of attack since Sen. William Proxmire denounced what he dubbed the National Science Foundation's "gay seagull study" in 1978. An amendment to rein in such studies by Rep. Pat Toomey (R) of Pennsylvania nearly passed in the House last year.
"Recent attacks by the traditional values coalition and others caught the scientific community by surprise," adds Mr. Koizumi, "There haven't been amendments like this in years."
In response, NIH supporters, including many of the disease advocacy groups that pushed for the funding surge in the 1990s, are reorganizing to defend the agency's funding and scientific independence.
"The Toomey amendment was a wakeup call for these groups, because of how close it came to being passed. They realized they need to do a better job educating lawmakers on how such social studies are as important a part of the NIH research mandate as cancer research," says Ms. Carney.
A first inkling of battles to come broke out as the Senate was winding down its budget debate on March 11. "I hate to say it. The NIH is one of the best agencies in the world, but they have turned into pigs, pigs.... They send a senator down here to argue as if they are broke," said Sen. Pete Domenici (R) of New Mexico, gesturing to suggest a porcine snout. "Of course, when you are a big science institute, you can invent something every day that you ought to do.... We are going to have a choice of keeping on funding [the NIH] or funding some other science in America before we have none left."
The 2005 budget crunch is forcing some difficult choices on a nation that prides itself in being at the front line of 21st century medical research. While the US is losing its edge in many manufacturing sectors, health-related research and industries are growing rapidly - and to many holds promise as a new bastion of high-wage jobs. "The entire biotechnology industry emerged from the fundamental basic research funded by the NIH," says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "The biotechnology industry owes its existence in a large part to the basic research that has been supported for decades by the NIH."
But experts say the rapid rise of Medicare and health-research spending creates a fiscal collision course on Capitol Hill. "It was a brilliant marketing push by the beneficiaries of the NIH budget. They came up with a slogan to double the budget in five years and it became a bipartisan mantra," says Chris Edwards, director of fiscal policy for the Cato Institute, a libertarian think tank. "We spend more on health because we're a wealthier nation, but Medicare and Medicaid can't be sustained," he adds. "We call it corporate welfare for the NIH to be doing the job of the pharmaceutical industry."
Hensarling cites a recent $276,000 NIH study of the sexual behavior of 80- and 90-year-old men - "What are we supposed to do with this information?" or a $3 million study of native American "two-spirited" individuals, he asks. "I'm quite confident that my constituents would rather see their money go into cancer research."