The Bush Budget

Unlike me, Judd Gregg is a U.S. Senator from the Republican Party, so you can expect him to be relatively sympathetic to George W. Bush's budget request for Fiscal Year 2009, dubbed "Managing for Results". Instead, he says:

"There's a lot of games, smoke, mirrors, incomplete numbers, basically there's not much realism'" in the budget, Senator Judd Gregg, the top Republican on the Budget Committee, said in an interview. "They're playing the usual games."

In Bush's defense, however, it should be said that all he's doing is actually proposing what conservatives are constantly saying should be done -- big increases in "regular" military spending combined with large expenditures on the war in Iraq combined with low taxes all made possible through the magic of reduced spending. So what did Bush come up with? Well, a proposal to have more Americans get sick and die:

The proposal [. . .] would cut discretionary spending by the Department of Health and Human Services by more than 2 percent in part by freezing the budget of the National Institutes of Health, which heads the government's medical research efforts.

The Centers for Disease Control and Prevention, meanwhile, would take a 6.2 percent reduction. The Health Resources and Services Administration, which helps the poor receive medical care, would be cut by 15.8 percent.

Depriving the population of health care and health care resources in order to make room in the budget for an indefinite military commitment to Iraq and the extension of tax cuts for rich people doesn't seem like a good idea to me, but apparently this is Bush's strategy for long-run economic growth.

Comments

Obviously, the health care cuts will be offset by the increased spending on abstinence-only sex ed, which will result in fewer people to get sick. Also, some of the sick people are probably well enough to go to Iraq.

Posted by Jen | February 5, 2008 11:32 AM

Traditional Medicare takes a big hit, but the overly generous reimbursements for private Medicare Advantage plans which pad HMO bottom lines remain.

Posted by bob h | February 5, 2008 11:34 AM

Actually abstinence-only doesn't work - leads to higher rates of pregnancy. But that's good too - replaces all the people who die from lack of health care.

Clearly the r in r-selected stands for "republican".

Posted by ajay | February 5, 2008 11:39 AM

But isn't it true that a great mover of recent national expenditures has been on health care?

Therefore if we could get more sick and elderly people to die sooner, more quickly, and more cheaply, we'd really be leaping ahead into that river that passes beneath the bridge to the 21st century!!!

Posted by El Cid | February 5, 2008 11:45 AM

It's called thinning out the herd. Would society be stronger if all low income people suffering from ill health died? Poor people disproportionally smoke and drink at higher rates relative to the general population. They eat themselves into obesity at higher rates. They engage in various activities resulting in death and injury at higher rates (see motorcycle riding, DWI, fisticuffs, etc). The resulting strain on our healthcare system is enormous. Additionally they rear children with a propensity to mimic their poor habits, creating a generational trend towards ill health. Lions cull the sick and lame from herds of gazelles for very sound biological reasons. The gazelle herd is ultimately stronger for the predation. We're a sick society for denying such mechanisms free play in our lives. Lacking lions we substitute conservative lawmakers who'll price our sick and lame out of health care. If you want back in prove you're willing to meet society half way. Quit your bad habits, don't be one of the lame dragging us all down. If you persist we'll leave you to die on the arid plains. Toodles!!

Posted by steve duncan | February 5, 2008 12:18 PM

Steve,

Why stop at these half measures? The truly enlightened end solution is to round them up and put them in camps away from the general population. That way they can be "treated" effectively for their afflictions. As someone famous (I forget who) said: "The world will not help, the people must help themselves. Its own strength is the source of life. That strength the Almighty has given us to use; that in it and through it, we may wage the battle of our life The others in the past years have not had the blessing of the Almighty - of Him who in the last resort, whatever man may do, holds in His hands the final decision. Lord God, let us never hesitate or play the coward."

Posted by z adura | February 5, 2008 12:38 PM

Who will be around to cut your grass and wash your car, Steve? A harvard grad who's between ceo-ships?

The better thing would be not give money back to the rich, increase the minimum wage, provide universal health care, and increase spending on education. Decrease the wealth gap and help those disadvantaged get going through a system that's already tilted against them.

There's so much wrong with what you wrote that it almost makes me sick. I hope some time in your life you'll be dependent on others, and I hope they turn you away.

Posted by brudy | February 5, 2008 12:44 PM

Freezing medical research just infuriates me. We lose 1,500 Americans a day to cancer. How many do we lose to terrorism? It's hard not to be a conspiracy theorist sometimes.

Posted by Bemused | February 5, 2008 12:47 PM

Am I the only one who figured Steve must have been snarking?

I think the focus on freezing the NIH budget and cutting HHS spending generally is a case of positioning. The administration knows a universal health care debate is coming in the next administration, and they want to push things as far to the right as possible before that debate begins. Republicans may not like the short-term political implications, but they'll be only too happy to have this in their corner when the time comes. The thinking goes something like, Democrats have a remarkable capacity for bad compromises, so let's go ahead and act like granting a small increase in these appropriations is actually a compromise position and see what we can get the Dems to give up when we magnanimously agree to it.

Posted by jhupp | February 5, 2008 12:52 PM

"There's so much wrong with what you wrote that it almost makes me sick. I hope some time in your life you'll be dependent on others, and I hope they turn you away."

Posted by brudy | February 5, 2008 12:44 PM

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
brudy, explain how society owes a lifetime three pack a day smoker quality healthcare after they've suffered a heart attack or contracted lung cancer. Why should I chip in to fix up some punk that has sped through a stop sign on a motocycle sans helmet and needs 6 months in a hospital and rehabilitation facility due to his recklessness? Why is society cleaning up the mess of adult onset diabetes in a woman that has eaten herself into a BMI of 50 and can't walk to the mailbox without stopping three times to catch her breath? If we continue to enable such self abuse society will get ever sicker. These are ingrained habits, dug in like ticks on a dog, and most of these people will not change. Period. Their attitude is "Fuck you, I'll eat and drink and smoke and dangerously fool around as much as I want. If I show up at your hospital fix me, discharge me, I've got bad habits to get back to. Oh, you want money? Hmmmmm, all out, it goes towards cigarettes, booze, McDonalds and my Harley." Turn enough of them away from a doctor and the message might start to sink in. If nothing else it'll stop their procreation.

Posted by steve duncan | February 5, 2008 1:05 PM

Depriving the population of health care and health care resources in order to make room in the budget for an indefinite military commitment to Iraq and the extension of tax cuts for rich people doesn't seem like a good idea to me,

It's called 'constituent service', or the customer satisfaction model.

Posted by Davis X. Machina | February 5, 2008 1:35 PM

Steve,

Society does not "owe" the poor, but even a blackened heart like yours understands that society ought to ensure that the poor can continue to offer their labor services to the non-poor. This is not necessarily possible when the food choices in their neighborhoods are Coke (thanks to the good subsidies of the sugar industry) and hamburgers (thanks to the good subsidies of the meat industry). Or when their only interface with healthcare is in the event of medical catastrophe (thanks to lobbying from the health insurance lobby). Or when their only access to sex education is through friends (thanks to well-meaning religious fanatics). Or when the rich in their immediate environments are sending their tax dollars to Washington to get redistributed to military adventurism. But, hey, if it makes you happier to tighten the belt on your smoking jacket and hate the poor, that's your choice.

Posted by z adura | February 5, 2008 2:16 PM

Agree with the overall point of the post, but I'm not convinced that any of these agencies have as much of an impact as is being assumed here. My impression is that these agencies are more propoganda machines for the current administration, talking about how healthy you can be if you would only stop having sex, stop smoking pot and get your BMI below a certain magical number indicating "healthiness," in much the same way that Cobert makes fun of a politician's "truthiness."

To say that people will get sick and die as a direct result of these proposed budget cuts seems a bit of a stretch.

Posted by mike | February 5, 2008 2:19 PM

"This is not necessarily possible when the food choices in their neighborhoods are Coke (thanks to the good subsidies of the sugar industry)...."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Ah yes, the local Coke distributor cut off the poor's access to..........TAP WATER!!

Posted by steve duncan | February 5, 2008 2:41 PM

Um, well, I'm a biochemist, so this won't make me real popular among colleagues, but -- freezing the NIH budget, which tends to grow ridiculously and can be surprisingly badly spent, isn't necessarily a terrible idea, and it doesn't _directly_ impact public health the way you're implying.

Posted by Sanjay | February 5, 2008 2:46 PM

Depriving the population of health care and health care resources

This would be a makeable argument if Bush was cutting Medicaid, which he isn't. The agencies you listed are bloated bureacracies that don't do anything.

The (NIH) Human Genome Project, for example, took fourteen years and $3 billion. During that span, independent scientist Craig Venter started and finished a parallel project in just under 6 years at less than 1/10 the cost. The NIH spent another $500 million to sequence the human genome after the project became moot.

Likewise, the CDC's only job seems to be in issuing press releases about phantom diseases (SARS, Ebola) so people like you get worried when somebody cuts their funding.

As for the "Health Resources and Services Administration," I've never heard of it and can't find any references to it from any source explaning what it does (any source not named the Health Resources and Services Administration, anyway), suggesting it doesn't have any effective function.

Posted by Shinyk | February 5, 2008 3:09 PM

Steve,

Thank you so much for making my point. The local Coke distributor is also the distributor for bottled water, which good marketing has enabled us to believe that tap water is unhealthy. In fact, tap water in most cities has improved over the last 15 years. Problem is, if people like you had their way, clean water would be as unavailable as good medicine, sex education and good nutrition: http://www.nrdc.org/water/drinking/uscities/pdf/chap07.pdf In other words, it is not a fait accompli that the poor will always have access to clean drinking water.

Someday you will have to come to the inevitable conclusion that we can spend our tax dollars on guns or butter. I definitely prefer butter.

Posted by z adura | February 5, 2008 3:16 PM

Steve - first off, show me some data demonstrating that poor people drink or do more drugs than rich people? Do you remember the 80's and coke? Come on. You're making a lot of claims with zero data. And no, I won't accept a Rush citation.

Second, re: eating habits. People at the lower end of the economic scale can't afford to eat healthy. They're working multiple part time jobs. They may be working at Whole Foods, but probably not shopping there. All they have time for is cheap fast food which can feed a family for under $10 a meal. You can barely cook dinner for less than that, or in that short amount of time. This is their life, they don't have other options. You want them to eat better, go start a food drive.

You write: "These are ingrained habits, dug in like ticks on a dog, and most of these people will not change. Period." Well, after centuries of oppression, that's probably what happens to people, especially when the system is stacked against them in almost every way.

Posted by brudy | February 5, 2008 3:19 PM

All they have time for is.......

Well, after centuries of oppression, that's probably what happens to people, especially when the system is stacked against them in almost every way.

Posted by brudy | February 5, 2008 3:19 PM
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Yes brudy, it is unfortunate the poor don't have the personal discretionary time to adopt a healthier lifestyle. Thank God the distillery and tobacco industries provide a quick, fully processed product. Otherwise all those poor people would have to brew their own drink and harvest & roll their own cigarettes.

Posted by steve duncan | February 5, 2008 3:33 PM

Steve,

I think you are either too young or too stupid to effectively argue your point. My hope is too young. Cheers.

Posted by z adura | February 5, 2008 4:00 PM

Steve - first off, show me some data demonstrating that poor people drink or do more drugs than rich people? Do you remember the 80's and coke? Come on. You're making a lot of claims with zero data. And no, I won't accept a Rush citation.

Second, re: eating habits. People at the lower end of the economic scale can't afford to eat healthy. They're working multiple part time jobs.

1. A lot of what this 'Steve' guy is saying is juvenile and ridiculous, but anyone who thinks poor people consume less ethyl alcohol (by volume) than other groups has likely not spent much time with either addicts or "the poor."

The very nature of alcohol and drug addiction forces earning potential into a nosedive (though there are exceptions, usually in Hollywood). Any experience with heroin or crack-cocaine addicts will immediately underscore that those addicts cannot hold professional (or even menial) jobs, forcing them into abject poverty.

Since alcohol and drug addicts consume more alcohol and drugs than non-addicts, and that addiction often forces poverty, "the poor"
consume more alcohol and drugs, per person, than the non-poor.

2. Any "poor" who are willing and able to work multiple jobs (at more than 40 hours per week total) cease to be "poor." They may still have low wages, but their overall income level takes them out of "poverty" (unless they have a gigantic family, which is another problem altogether).

3. Groceries from "whole foods" are cheaper than eating fast food every day at McDonalds. However, many poor people still seem to eat at McDonalds at least as often as they cook for themselves, which I've always found inexplicable. There is some other factor at play that often forces poor nutrition.

My own experience working with the poor suggests they consist of four different groups

1) people who are in some way defective (addicts, criminals, sociopaths, high school dropouts, morons, lazy people, the mentally ill)
2) the temporary poor (recovered addicts or those who have simply had a string of bad luck). These people crawl out of poverty relatively quickly.
3) Unskilled immigrants (the second generation always seems to escape poverty)
4) Otherwise capable people who have in some way been black-balled by polite society (such as a young, educated black male who can't find work due to an assault conviction at age 18)

Groups 1 and 3 seem far more numerous than 2 and 4, but that just might be my experience.

Posted by Shinyk | February 5, 2008 4:22 PM

Um, well, I'm a biochemist, so this won't make me real popular among colleagues, but -- freezing the NIH budget, which tends to grow ridiculously and can be surprisingly badly spent, isn't necessarily a terrible idea, and it doesn't _directly_ impact public health the way you're implying.

Um, well, I'm an epidemiologist, and you're dead wrong. The NIH budget has been more or less frozen for the past several years, and while it generally funds research that takes many years to see the benefits of, it is important work. If you biochemists are so awash in cash, maybe you could send some over to public health so I can pay my staff.

Posted by ed | February 5, 2008 6:20 PM

Shinyk- You are wrong on the HGP and Celera.

http://www.sanger.ac.uk/HGP/publication2001/comparison.shtml

Celera was then founded in 1998, claiming that a whole-genome shotgun was superior, and that they would finish faster. Only, the whole-genome shotgun was shit by itself, and depended on HGP clone and marker maps for full reassembly. Data that was available to Celera because the HGP was an open project.

After years of refusing to release their raw datasets, a final analysis demonstrated that Celera's complete-shotgun methods were a failure, their claimed ability to dispense with HGP-style clone mapping was a wash, and their published results relied absolutely on the same HGP maps they derided in the press.

The HGP/Celera issue is a perfect microcosm of biotech research, a publicly funded body performing the hard groundwork, the basic research, and actually producing the final product, and a shitty little company attempting to extract the maximum of unearned profit, using freely-given public information to fill the gaps in their shitty mechanisms, agreeing to share data with the public company when it gains them good publicity then taking public data and refusing to release their own, releasing a shitty final product and being cited by shitty posters like yourself as proof of the inevitable superiority of the private sector.

Posted by bbeans | February 5, 2008 7:47 PM

The HGP/Celera issue is a perfect microcosm of biotech research, a publicly funded body performing the hard groundwork, the basic research, and actually producing the final product,

I bet I can name your employer in only one guess.

I knew a guy who used to work for the ONDCP. He swore up and down that that agency's work was the absolute most crucial thing that could ever be done for this great nation. He got a new job and now acknowledges that his former agency is nothing but an ineffective, pointless propaganda outlet that ought to be junked immediately.

Posted by Shinyk | February 5, 2008 8:05 PM

Nobody disagrees with you the ONDCP or a larger discussion on illegal drugs?

Posted by bbeans | February 5, 2008 8:31 PM

Nobody disagrees with you the ONDCP or a larger discussion on illegal drugs.

Posted by bbeans | February 5, 2008 8:31 PM

Smoking, obesity, and their co-occurrence in the United States: cross sectional analysis
Cheryl G Healton, professor of clinical public health1, Donna Vallone, associate vice president of research and evaluation2, Kristen L McCausland, research associate2, Haijun Xiao, research analyst2, Molly P Green, research associate2

1 Columbia University, Mailman School of Public Health, New York, NY, USA, 2 American Legacy Foundation, Washington, DC 20036, USA

Abstract
Objectives To describe the prevalence of obesity, smoking, and both health risk factors together among adults in the United States.

Design Cross sectional analysis of a national health interview survey.

Setting United States.

Participants 29 305 adults (aged 18) in 2002.

Main outcome measures Prevalence of adults who are obese (body mass index 30), who smoke, and who are obese and smoke. Prevalence was stratified by age, sex, ethnic group, education, and income.

Results 23.5% of adults were obese, 22.7% smoked, and 4.7% smoked and were obese.

Conclusions Although the proportion of adults who smoke and are obese is relatively low, this subgroup is concentrated among lower socioeconomic groups.

Introduction
Obesity and cigarette smoking are primary risk factors for several chronic conditions and early death in a large number of people in the United States. The prevalence of smoking among adults is 22.5% (45.8 million people).1 The proportion of obese adults is also high—about 31% of adults have a body mass index of 30 or more.2 Although smoking and obesity are public health priorities in the US,3 the overlap between the two conditions has not been measured at population level. Because the presence of these two conditions together probably carries an increased risk to health, statistics on how these conditions overlap could help in the development of an effective policy for prevention and treatment.

Methods
We used data from the 2002 national health interview survey (NHIS) to conduct a cross sectional analysis of 29 305 adults ( 18 years) and estimate the proportion of adults in the US who smoke and are obese. Prevalence was stratified by various sociodemographic factors. Rubin's multiple imputation procedure was used to replace missing values of family income. We analysed all data with Stata software, version 8 and adjusted the results with sampling weights to derive population estimates from the survey sample.

Results
Nearly 41.5% of adults (81 million aged 18 years) in the US are obese or smoke, and about 4.7% (9 million) smoke and are obese (table). Overall, 5.3% of men and 4.2% of women smoke and are obese. This proportion is higher in African Americans (7.0%) than in other racial or ethnic groups. A greater proportion of people with lower income and education levels smoke and are obese. With the exception of the over 65 age group, in which the prevalence of both conditions is low (1.1%; probably because these risk factors are associated with early death), little variation occurs across age groups.
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Poor people are their own worst enemy. They insist on abusing their bodies. The financial consequences to our healthcare system are dire and provable. The lost manhours to employers are significant, representing a drag on our national economy. Make all the excuses you want. Being poor is not in and of itself a license to slowly kill yourself through neglect.

Posted by steve duncan | February 5, 2008 8:57 PM

The (presumeably) incoming Democratic president will NOT be able to deal with this. It is unpopular and extremely difficult to battle the military bureaucracy and cut or freeze spending, even on non-war expenditures, in a time of war. bush cuts federal healthcare expenditures to pay for some of it (and borrows the rest, because the Republican party is the party of fiscal responsibility); what will the Democrats cut to pay for increased healthcare expenditures? as enormous and wasteful as all this federal military/security/defense spending is, it's worth remembering that entitlements still make up the bulk of federal spending (sorry no link but i've seen it cited all over from multiple sources). i'm not saying that's necessarily bad, healthcare is important and widespread preventative care would actually save money in the long run, unlike most of this runaway defense spending, which only benefits a small segment of the economy and which is largely unneccessary.

but again: how will we balance our budgets?

Posted by sv | February 6, 2008 10:40 AM