Why are Republicans fixated on holding middle class Americans hostage to their campaign to prevent government spending on preventive health services? Senate Republicans have just blocked legislation to keep college loans affordable by adhering to House Speaker John Boehner's promise to condition Republican support for keeping interest rates from doubling by cutting $6 billion from the Prevention and Public Health Fund. Earlier this year, Republicans actually bragged that they cut these funds by $5 billion when they grudgingly agreed to extend the middle class tax cuts without also cutting taxes on the wealthy. The Republican spin is that they are scaling back "Obamacare." Politics trumps health. Never mind that the Republicans' latest move will effectively zero out monies for reducing America's rising health care costs.
In designating public health funds as ransom for affordable college loans, Boehner called them "slush funds." Accusing his opponents of engaging in "campaign-style theatrics," he implied that investment in initiatives to prevent human suffering wastes taxpayers' dollars. Presumably, in the Republican playbook, the Democrats' proposals for financing low-interest rates on college loans by ending tax subsidies for oil and gas companies or increasing the Social Security and Medicare payroll taxes on high earning stockholders are mere "theatrics" aimed at preserving profligate public health spending.
This curious characterization of preventive health expenditures as "slush" raises the question of why Republicans are unable or unwilling to appreciate the benefits of investing in public health. In particular, why do they oppose efforts to reduce our enormous expenditures on medical care for sick people by cost-effective investments in programs and services to keep people from getting sick?
As its name implies public health protection refers to a government responsibility. This includes protecting communities from contaminated food and water, disease-carrying mosquitoes and tainted blood products and promoting smoking cessation, healthy diets and exercise. This is to be done while ensuring access to vaccinations and reducing children's injuries and responding to emergencies to prevent the spread of disease and assist people in distress. These are services that promote the well-being of individuals and society.
The Republicans recent assault on public health is particularly troubling for several reasons. First, they have politicized an issue that should be a shared enterprise. A physically healthy population is essential for our country's economic growth and national security. Last month The Institute of Medicine issued another report bemoaning the woeful state of America's public health infrastructure. It called our lack of public health funds "dysfunctional" and documented the negative impact that insufficient spending has on life expectancy and health outcomes compared with other developed countries.
Republicans have also confused the issue of preventive health funding with their obsession to impose their moral values on society. Grandstanding their intention to defund Planned Parenthood in reality means denying women access to the preventive services that detect breast, cervical and uterine cancers and that enable them to choose whether or when to get pregnant. Moreover, cutting these funds reduces the government's ability to address the health challenges plaguing marginalized populations. The Department of Health and Human Services just released a report documenting the negative health outcomes experienced by racial and ethnic minorities, people with disabilities, and lesbian, gay, bisexual and transgender communities who face barriers to health services.
Finally, failing to support public health weakens our nation's security. It is ironic that given limited funds and competing needs, Republican budget proposals cut human services and increase defense spending. Do politicians believe that disease pathogens or virus-carrying insects distinguish between humans wearing military uniforms and civilians? Public health departments monitor disease outbreaks and mobilize appropriate responses. With up to 10 million people annually crossing international borders, the potential for human transmission of the deadly H5N1 pandemic virus, the threat of bioterrorism using lethal germs or weaponized bacterium (think anthrax), how can they brag about cutting already woefully inadequate public health funds?
To be sure, Republicans can claim that they want only to cut the "slush." Presumably, their political wisdom endows them with the capacity to foresee the future and minimize its threats. Perhaps that is why prior to the 2009 pandemic they cut funding for research that might lead to speeding up vaccine production, or why prior to Hurricane Katrina they delayed funding for strengthening the New Orleans levee system. Maybe that is why they appear unconcerned about the health needs of women, minorities, or the 40 million people who lack health insurance.
Public health funds should not provide the ransom for funding programs that benefit middle class families. Since Republicans are fond of quoting our Founding Fathers, perhaps they should heed the words of Benjamin Franklin, "An ounce of prevention is worth a pound of cure."
Leslie Gerwin is Associate Director, Program in Law and Public Affairs, Princeton University; she teaches Public Health Law and Policy as an Adjunct Professor of Law at the Benjamin N. Cardozo School of Law.
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