When it comes to the nation’s health, the Trump Administration and the GOP-dominated Congress seem determined to prove they know how to do penny-wise and pound-foolish. They’re amply demonstrating this with proposed slashes in the nation’s basic budget for public health. They’re calling for a $1 billion cut for the Centers for Disease Control and Prevention, notably in the agency’s funding to combat bioterrorism and outbreaks of disease, as well as to battle smoking and to provide critical medical services like immunizations. Their target is the Prevention and Public Health Fund, set up under the Affordable Care Act, aka Obamacare. With the ACA under fire by partisans who want to repeal and replace it, the fund was already imperiled. GOP lawmakers, determined to cut domestic spending, seem disinclined to come up with substitute sums.
Andy Harris, a Maryland Republican congressman, physician, and House appropriations health subcommittee member, has been quoted as calling the public health money, “a slush fund.” He argued that, “It’s been used by the secretary [of health and human services] for whatever the secretary wants. It’s a misnomer to call it the Prevention and Public Health Fund, because it’s been used for other things, and it’s about time we eliminated it.”
The Obama Administration did embarrass Congress by tapping the fund to provide emergency aid last summer to Florida, Puerto Rico, Hawaii, and other states battling tropical infections, including Zika and dengue fever. Congress took a long recess vacation, as states clamored for help for mosquito eradication and vaccine development to deal with Zika, a virus that can cause severe birth defects and other harms.
In an earlier, international public health crisis, President Obama confounded partisans by finding funds, including from the CDC, to battle a deadly Ebola outbreak—with dispatch of medical and military logistics personnel to afflicted nations and evidence-based prevention efforts in this country. He resisted strident calls for immigration and border crackdowns against Africans and nations in Africa.
President Trump and the GOP, of course, want to slash domestic spending while ramping up funding for the military and anti-immigration efforts. Trump has not specified how much, for example, he wants for his border wall with Mexico, though it has been reported that he’d like at least $3 billion for it soon.
Reasonable Americans may want to ask if it is evidence-based to jack up funding for the military and homeland security at the cost of critical programs like public health. Must we go either-or? It’s worth noting that since 9/11, experts say that 95 Americans have died in terrorist-related incidents, all perpetrated by those already in this country, while 55,000 Americans per year die of influenza or pneumonia alone—illnesses whose harms can be reduced by prevention, including immunization.
I’ve written about the Trump Administration’s risky encouragement of the anti-vaccination fringe. I’ve noted that the nation’s experiencing unprecedented outbreaks of whooping cough, measles, and mumps. These infections, along with the virus that causes cervical and other infections, can be better managed with robust vaccination programs, many funded by the CDC. Why would we want to cut back in this area? It’s also unacceptable that, even as Big Tobacco is pushing Americans, especially the young, to try new means of getting addicted to cigarettes, e-cigarettes, hookahs, pipes, cigars, and nicotine that one of the key agencies to fight this health scourge would lose its resources to do so. Have the president and members of Congress forgotten that 1 in 5 deaths in the United States are caused by smoking?
It’s also unhelpful for the CDC that President Trump and his people haven’t yet replaced the influential agency director. The administration has struggled to fill top posts, partly because of its avowed hope to disrupt Washington’s bureaucratic ways. This approach, for example, had stalled the appointment of the powerful head of the federal Food and Drug Administration. After waiting for the U.S. Senate confirmation of Tom Price as secretary of the Health and Human Services Department and considering an array of eyebrow-raising, inexperienced Silicon Valley venture capitalists, the president apparently has decided to nominate Scott Gottlieb for the top FDA post. He is a physician, onetime Bush Administration official, and a conservative activist. He has extensive, controversial ties to Big Pharma, has been a major FDA critic, and works with venture capitalists, too.
He should get close scrutiny, as should any new CDC chief, and the proposed slashes in public health funding and any changes with the FDA and its processes to oversee drugs and medical devices. In my practice, I see how detrimental it can be for patients to seek costly medical services, to be harmed by them, and then to need to seek justice and potentially a lifetime’s economic support. Staying healthy can be vital to us all—and it should be a more cost-effective path to pursue than pricey therapies. Congress and the president should re-think their priorities, and see how smart public health spending can be.