The budgetary hot-air wars gripping Washington have spotlighted all the elements that have degraded of 21st century politics: Apocalyptic threats of a government shutdown, high-decibel debates over budgetary irrelevancies (the drive to defund Planned Parenthood
), angry denunciations of do-nothing government bureaucrats and vapid presidential slogans ("Win the Future").
Even when the congressional fiscal follies momentarily take a serious turn, an abstract tone dominates these floating numbers games involving slashing tens of billions. Budget arithmetic turns into an alternative reality as numbers are tossed around disconnected from real-world implications for federal programs.
Missing is an honest discussion of how potential cutbacks undermine governmental programs that both conservatives and liberals traditionally support.
A prime example is the $5-billion National Cancer Institute (NCI), part of the $31-billion National Institutes of Health
(NIH). Aside from ideologically pure libertarians who probably think that Thomas Jefferson went too far with the Louisiana Purchase, no one believes that battling cancer should be left to the private sector and the vagaries of the profit motive. Since the Cancer Institute (like the NIH) spends nearly 80 percent of its money on grants, it is difficult to portray these medical research agencies as exemplars of bloated Big Government.
The arbitrary nature of the budget battles means that NIH is on the chopping block along with the rest of discretionary domestic spending. The problem is that even a small percentage cut in biomedical research disproportionately hobbles funding for new research projects. This counter-intuitive point was at the heart of an interview I had last week with Harold Varmus
, the director of the National Cancer Institute and (full disclosure alert) a friend.
Few in government know as much about biomedical research as Varmus, the co-winner of the 1989 Nobel Prize for Medicine and the director of the NIH during the Clinton years. Varmus is not in the business of offering dire warnings to Congress ("I don't like to whine about this stuff") or engaging in budgetary antics like the Washington Monument ploy.(During a budget crisis decades ago, the Interior Department supposedly decreed that the first thing that had to go was tourist visits to the Washington Monument).
"The most important new thing we do every year is to make new awards to people with new ideas," Varmus said. "Yet we have obligations to people who got grant awards last year, the year before and the year before that." With grants lasting as long as five years, Varmus explained, the National Cancer Institute is locked into long-term commitments. NCI also helps fund a national network of leading cancer centers
(like Dana-Farber and M.D. Anderson), which treat about 15 percent of the nation's cancer patients. Throw in funding clinical trials, offering medical training programs and supporting the NCI's in-house research – and there is not much give in the Cancer Institute's budget.
That is why new grants are so vulnerable as the government lurches from continuing resolution to continuing resolution. From his days at NIH, Varmus operates on the rough rule of thumb that "the system works well if you are funding one-third of your new grant applications." These days, the NIH as a whole is backing only maybe one-sixth of new grant requests. "When you're only funding 10 or 12 percent," Varmus said, "you really can't make the distinctions between applicants that we're being asked to make. So everyone gets very conservative – the experts who review these things tend to make very conservative decisions."
After a dramatic expansion between 1998 and 2003, the budget for the entire National Institutes of Health (as well as the NCI) has been essentially flat for nearly a decade. Adjusting for inflation, NIH's buying power is at roughly 2002 levels. After the failure of the Democratic Congress to pass any appropriations bill for the current fiscal year and with the House Republicans recently slashing $1.6 billion (5.2 percent) from the NIH budget
, Varmus has no idea where spending levels for the Cancer Institute will end up. "What's unprecedented for me is to have a continuing resolution that is really a cut," he said. "That would put us back to 2008 spending levels."
While there are gambits that Varmus is using to maintain flexibility for new research ("We do a little skimming and give everyone a haircut to try to keep the grant numbers up"), he and his colleagues at NIH do not have much room for maneuver. As he puts it bluntly, "The number of new grants gets severely curtailed even with a 2-to-4 percent reduction." With no more than 20 percent of NCI's budget devoted to new grants, even a $300-million cut in funding would send shock waves through the nation's cancer research community.
There is a larger point here than pleading for more money for cancer research, even though we all have friends and loved ones
who have died all too young from the disease.
Federal domestic spending consists of thousands of program lines – many far more worthy than others. By taking a meat cleaver to the budget, House Republicans are making only the crudest distinctions between government programs. This kind of fiscal Neanderthal-ism may play well with the voters who ousted Nancy Pelosi as House speaker. But it is no way to run a government – or to fight cancer.
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