Given what the federal “sequestration” projections portend for medical research expenditures and the vital work that the money supports—barring intervention from Congress—that relatively paltry $33 million might suddenly look a lot larger to the scientific community.
The automatic budget cuts set to take effect March 1 would slash some $85 billion from overall federal discretionary spending for 2013 alone and more than $1 trillion over the next 10 years. While healthcare entitlements are essentially protected, everything else is in harm's way. In healthcare, that includes the National Institutes of Health, the Centers for Disease Control and Prevention and other HHS agencies.
President Barack Obama last week decried what he called a “meat cleaver” approach to addressing our national debt and budget deficits. But Mr. President, we haven't seen much aggressive action on your part to wrestle that cleaver away. Meanwhile, House Speaker John Boehner blamed the White House for first advancing the concept of sequestration and then telling Obama to clean up the mess. Of course, he ignored the role of Republican lawmakers' in signing off on the law.
Regardless of how or if sequestration can be avoided, spending reductions are coming. The discussion has to focus on what should be spared the deepest cuts. The Pentagon certainly can lose some of its bloat, but Defense cuts at expected levels, $46 billion this year alone, are too deep. The same is true for other sectors where sustained investment is imperative. They include public safety and education. And healthcare research.
According to Research America, a not-for-profit organization that advocates for medical research, funding for the NIH has remained essentially flat in recent years, totaling $30.9 billion for 2012. But inflation has significantly eroded the agency's purchasing power, by about 3% in each of the past two years based on a measure called the Biomedical Research and Development Price Index. Sequestration is now expected to require 5% across-the-board spending cuts, threatening the value of cutting-edge research in progress as well as future grants.
While the NIH's work is vital to universities and research organizations nationwide and essential to discoveries that might finally end so many horrific diseases, the agency also could benefit from stepping up oversight of grants already awarded, reassuring taxpayers about the stewardship of its limited funding. Transparency is the name of the game in government and especially in healthcare, given the unrelenting cost spiral that's sucking so many dollars out of the treasury.
With those costs in mind, another area where sustained investment makes sense is the realm of comparative effectiveness. The goal is to find out which medicines, devices and treatments actually work. If such studies result in healthcare “rationing”—that is, weeding out ineffective care and the resulting wasteful spending—then let the rationing begin.
The Agency for Healthcare Research and Quality as well as the Patient-Centered Outcomes Research Institute—mandated by the Patient Protection and Affordable Care Act—are charged with much of this work. They have comparatively small budgets that are worthy of increased investment, especially given the task at hand.
David May, Assistant Managing Editor/Features