Sean Philpott: Sequester This
As many of us expected, our leaders in Washington were unable to overcome their ideological differences long enough to actually do something about the looming and manufactured deadline for federal budget cuts known as the 'sequester'.
Included as part of the Budget Control Act of 2011 -- itself a compromise to deal with the manufactured debt ceiling crisis -- the sequester mandates that $1.2 trillion be cut from the federal budget over the next decade, including $85 billion between now and September when the federal fiscal year ends. It would be nice if that $85 billion could be taken from Congressional salaries, seeing as how our Representatives and Senators aren't doing much. Since it cannot be taken from their paychecks, we have to find other ways to slash this money from the current federal budget.
Now $85 billion doesn't seem like a lot when you consider that the federal government is expected to spend $3.8 trillion in 2013. This year's mandated cuts amount to less than three percent of total federal spending. The problem is that much of current government spending is from mandatory programs like Social Security and interest payments on the national debt, which are excluded from the sequester.
The bulk of the spending cuts will fall on discretionary spending programs, both military and domestic, along with an additional $10 billion in cuts to Medicare. The impact of these arbitrary and ill-conceived cuts on public health and safety are likely to be enormous.
For example, the US Food and Drug Administration (FDA) -- the federal agency that, among other things, oversees food safety and licensing of new drugs -- faces an eight percent cut in its budget this year. Slashing $300 million from the FDA's budget means that review and approvals of new drugs or medical devices are likely to be delayed, and inspections of drug manufacturing facilities reduced. New brand-name and generic drugs will be slower to enter the market, consumer costs will likely rise, and existing drug shortages will be exacerbated.
Budget cuts also mean that our food will soon be more expensive and less safe to eat. The FDA currently oversees 80 percent of the US food supply, with the US Department of Agriculture (USDA) overseeing the other 20 percent. Reductions to the FDA's budget mean that it will conduct considerably fewer food safety inspections in the coming year. The Agency will also delay or scrap existing plans to hire and train new inspectors, to work with farms and food distribution companies to create detailed safety plans, and to create a new system for inspecting imported foods.
The USDA's Food Safety and Inspection Service, in charge of meat and poultry safety, faces similar cuts. Meat and poultry inspectors will likely be furloughed for up to 15 days at a time. As USDA inspectors must be present for a plant to operate, the furloughs mean that some meatpacking plants will have to shut down. While this won't affect food safety, it will affect consumer prices. The price of filet mignon and chicken fingers is likely to rise at your local ShopRite.
The budget of the US National Institutes of Health (NIH) will be slashed by $1.6 billion this year alone. The NIH is one of the largest public funders of biomedical research in the world, supporting the development of new treatments for the various diseases and conditions that currently drive healthcare spending in the US. In order to achieve the required reductions in spending, the NIH plans to turn down over a thousand new requests for research funding from the nation's top labs and medical schools.
According to former NIH Director Elias Zerhouni, appointed by President George W. Bush in 2002, these changes in NIH funding priorities will be devastating. Not only will scientific innovation be slowed, but cuts to NIH-funded programs to train and support young investigators may lead many to abandon the field of science altogether. This will lead to a "generational gap" among researchers that will affect science for decades to come.
Finally, the sequester means that Medicare -- which provides health coverage for nearly 50 million disabled or elderly Americans -- will face a two percent cut in its budget this year. Again, this doesn't seem like a lot of money until you consider that these cuts come after years of stagnant funding. Medicare payments for services have increased by only four percent since 2001, for example, while the cost of actually caring for patients has increased by nearly 25 percent.
The only way that doctors and hospitals can continue to absorb these costs is by eliminating jobs and slashing services. One study suggests that nearly 300,000 healthcare industry jobs will be lost this year alone, meaning that all patients -- those on Medicare and those with private insurance -- are likely to face longer wait times for appointments and additional delays in receiving treatment and care.
There are plenty of people around the country, from pundits to politicians, who are in favor of the sequester. These mandatory cuts to the federal budget, they believe, will help rein in out-of-control government spending despite the inability of Congress to make difficult but necessary deficit-reduction decisions. But the capricious and arbitrary nature of these spending cuts endangers the health and safety of us all. If anything, key agencies and federal programs like the FDA, NIH and Medicare should be shielded from further cuts rather than be subject to the bulk of them.
A public health researcher and ethicist by training, Dr. Sean Philpott is Director of Research Ethics for the Bioethics program at Union Graduate College-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of Union Graduate College's Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.
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