The ACP Advocate Blog
by Bob Doherty
Wednesday, February 27, 2013
Dumb and Dumber
Sequestration is a dumb idea—plain and simple. It is a dumb idea if you are a Democrat. It is a dumb idea if you are a Republican. It is a dumb idea if you are an independent. Even dumber is that fact that Congress and the President inflicted this dumb (and totally unnecessary) crisis on us and are wasting time now by blaming each other for who came up with the dumb idea in the first place—rather than solving it.
(For the record, sequestration—across the board budget cuts that will go into effect on March 1--is the handiwork of both parties. The President proposed it to break the impasse on re-authorizing the debt ceiling in the summer of 2011, a fiscal crisis brought on by House Republicans who refused to pass a routine bill to increase the ceiling without an agreement to cut spending. To overcome this impasse, majorities of Republicans and Democrats in the House and Senate then voted for the Budget Control Act of 2011, which included sequestration as a back-up plan to reduce the deficit that was intended to go into effect only if a congressional “Super-committee” couldn’t come up with an agreement on a better way to achieve savings. The “Super-committee”—made up evenly of Republicans and Democrats, House and Senate—deadlocked and couldn’t produce a plan, and as a result, the Act required that sequestration be instituted on January 1 of this year. On January 1, 2013, both the House and Senate reached a last-minute bipartisan agreement, signed into law by President Obama, to postpone sequestration until March 1. And here it is now, with fewer than 48 hours left, and there has been no serious effort by either party, by the House and Senate, or by the White House, to come up with a bipartisan plan to stop sequestration.)
How dumb is sequestration? Well, let’s say you were the mayor of a mid-size city, your budget is deeply in the hole, creditors are at the door, and you realized you have no choice but to reduce your debt. Would you:
1. Cut all of your expenses by the same percentage amount—the money set aside to stop an unsafe bridge from collapsing; the money allocated to pay the salaries of teachers, police and firefighters; the taxpayer money you asked for to buy nicer furniture for your own office; the money for that all-expense-paid trip to Palm Springs (golf included) that you and the city council want to take to “network” with other mayors (including attending that cool symposium on how to control your city’s spending), and the budget for medical care and shelter for the homeless?
2. Prioritize your spending, cutting some categories by more, some by less, and some not at all—protecting the money set aside to stop an unsafe bridge from collapsing, the money allocated to pay the salaries of teachers, police and firefighters and the budget for medical care and shelter for the homeless, over new furniture for your office and the trip to Palm Springs?
3. If prioritizing your spending isn’t enough to close the gap, ask your wealthiest residents to pay a little bit more to help preserve funding for the most essential and effective programs that benefit everyone, but especially, the least well-off in your city?
Most of us, I think, would agree that #2 and #3 are pretty smart, and #1 is just plain dumb. Yet #1 is exactly what sequestration is all about--it cuts federal programs by the same amount, no matter how good or bad, how essential or non-essential, how effective or ineffective, how important or unimportant, how many are helped by the program cut.
And although there are some in and outside of Washington who argue that sequestration will do no harm, the sequestration cuts to healthcare will have a real impact on access, quality and public health and safety, maybe not all at once, but before too long, and the longer they are allowed to remain in effect, the greater the damage. ACP’s State of the Nation’s Health Care report, released last week, documented the impact, including:
1. Medical research to prevent and cure diseases will be curtailed. The cuts would result in 2,100-2,300 fewer NIH research grants, and Research Proposal Grant (RPG) success rates would drop from 18 percent in FY2011 to 14 percent in FY2013.
2. Funding for programs to train more physicians, especially primary care physicians in under-served areas, will be slashed: 295 fewer scholarships for minority and disadvantaged health profession students, a loss of funding midway through their training for 14 primary care residents; 2,315 primary care physician and physician assistant trainees adversely affected by reduced funding for the Title VII Primary Care Training and Enhancement Program, and 14,760 fewer public health professionals trained through the Title VII Public Health Training Center Program.
3. Patient access will suffer and jobs will be lost as Medicare payments to hospitals, physicians, and physician residency programs are cut. Altogether, Medicare will be cut by $11 billion in 2013 under sequestration resulting in a loss of nearly 500,000 U.S. jobs. But the biggest impact will be on seniors and disabled persons who rely be on Medicare coverage to enable them to access quality health care. Although guaranteed benefits will not be directly reduced by sequestration, cuts in payments to physicians and hospitals will force many of them to lay-off staff, curtail services, and limit how many Medicare patients they can see. Physicians and other clinicians may have to lay off as many as 62,000 employees if sequestration goes into effect. In the case of physicians, the sequestration cut is a prelude to a much larger scheduled cut on January 1, 2014 as the result of Medicare’s flawed Sustainable Growth Rate formula.
4. The federal government’s ability to prevent and control diseases and to ensure the safety of food and drugs will be compromised. Funding for the Food and Drug Administration will be slashed by $191 million and for-the Centers for Diseases Control and Prevention by $444 million over 10 years starting in 2013.
How dumb it that—to train fewer primary care physicians when we know that the country is facing a massive shortage, to lose our edge in medical research, to make it harder for Medicare patients to find doctors, to make our food and drugs less safe, to make it harder to detect and prevent the next flu outbreak or pandemic? When there are far better ways to reduce unnecessary health care spending?
But before we just blame the politicians for their cognitive impairment when it comes to the federal budget, we should look in the mirror. Polls show that a majority of Americans want the focus of deficit reduction to be mostly on spending reductions rather than tax increases, but this general support for spending cuts doesn’t translate into support for cutting any specific category of spending. Rather, a recent poll shows that the public rejects spending cuts for 18 out of 19 categories of spending; the “only exception is assistance for needy people around the world. Nonetheless, as many say that funding for aid to the needy overseas should either be increased (21%), or kept the same (28%), as decreased (48%).” (Only 22% favored cuts in health care spending, and only 15% supported cuts in Medicare).
So we Americans want to cut the deficit, we want deficit reduction to focus mainly on spending cuts rather than higher taxes, but we reject cutting anything other than the miniscule amount of federal money spent on foreign aid? That is, no cuts in any program that benefits us directly. Now, how dumb is that?
Today’s questions: What is your take on the budget sequestration mess? How should the country get out of it?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
- Time is on My Side
- Not in My Lifetime
- Blaming the Patient
- Is Global Capitation a Better Way to Pay Primary ...
- Curiouser and curiouser!
- Can Team-based Medical Homes Eliminate the Primary...
- The Good, the Bad, the Ugly, and the Really, Reall...
- The Fiscal Cliff is Coming to Town
- Is the medical profession doing enough about gun v...
- Cliff Notes
The Wall Street Journal's blog on health and the business of health.
Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.
The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.
Vignettes and commentaries on the medical profession.
The New Health Dialogue Blog
From the New America Foundation.
DB's Medical Rants
Contemplating medicine and the health care system
Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.
A blog dedicated to medical education, news, and policy as well as career advising.
Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.
Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.