One of the ironies of Republican Administrations is the claim of wanting smaller government by eliminating unessential government programs while preferentially targeting the effective programs that are already in place. Sometimes the reason is clearly ideological (
example and see p11-12: abstinence programs don't work as well as comprehensive sex education programs, but are ideologically pure).
"...[T]he committee recommends that: Congress, as well as other federal, state, and local policymakers, eliminate requirements that public funds be used for abstinence-only education, and that states and local school districts implement and continue to support age-appropriate comprehensive sex education and condom availability programs in schools."
Institute of Medicine, 200142
The WaPo today has an article about "previously untargeted programs" above and beyond the usual targets that have been slipped into the Bush budget.
Health and Human Services programs would face significant cuts. The Bush plan would kill seven Health Resources and Services Administration programs that earmark money for
emergency medical services for children, hospital construction, traumatic brain injury and newborn hearing screening. Despite the national rise in child obesity, the White House wants to eliminate a $59 million media campaign to encourage children ages 9 to 13 to be more physically active, judging it redundant given similar drives by Nickelodeon and the Disney Channel.
Oh, okay, I got it. Outsource childhood obesity management to the Disney Channel, who can tell the kids sitting in front of the TV to lose weight by turning the set off and going outside to play. Right. I guess that's why we're reality-based and they're not. Well, one can argue about that, and one can argue about hospital construction (not every program is for altruistic reasons, yet if hospitals can't remain in the black, they can't serve the community), but cutting Emergency Medical Services for Children?
EMSC is a program that grew out of an Institute of Medicine report in the mid-80's to make certain that ambulances and ERs taking care of kids have appropriate weight- and size based equipment available. Oxygen masks and breathing equipment, intravenous fluid administration, medications and a host of emergency techniques require both training and supplies for children that are radically different than for adult heart attack victims. Legislation mandating EMSC was passed by Congress in 1986, iirc.
By this time, the need to assure children's emergency needs, equipment and training has been codified and is now mandatory across the country. Many states deal with this now, and it is certainly possible that the intent of the cuts is to focus the burden of assuring EMSC back on the states, many of whom have already strapped budgets due, in part, to excessive GOP-pushed tax cuts (CT is such a state). Without federal guidelines, monitoring and assistance, however, cash-strapped states will be sorely tempted to let these programs wither.
Similarly, newborn screening requirements arose from the observation that a typical newborn exam done by an obstetrician or pediatrician was inadequate to pick up cases of congenital hearing loss, and that early identification could improve cognitive outcome. Hearing screens are now mandatory in many states. But the equipment and training is expensive and without a federal push, the future of such programs is unclear (unless programs like this are mandatory those that can afford it will get it, those on Medicaid or without insurance may not). Again, some hospitals outsource the mandatory testing to private groups so as to not have to maintain the equipment.
What we're seeing here is more of Bush's idea of just what 'ownership society' means: a two tier health system where those that can afford it get superb care, while those on state insurance get cut off from programs from private providers who refuse to take patients without blue-chip insurance.
Now that's not to say we don't have such a system now (and that's always been a powerful argument for a single payor system). But by hiding the cuts in a Friday release, Bush hopes to get the credit for fiscal responsibility without having to explain why these programs favor private purveyors of health.
The White House released the list of program cuts in response to congressional requests, sending it to lawmakers late on a Friday afternoon, when it would receive relatively little attention heading into the weekend.
The timing underscored the political calculations involved as Bush attempts to fulfill his vow to cut the federal deficit in half by 2009 while still paying for wars in Iraq and Afghanistan and financing his ambitious proposal to restructure Social Security. While it may be politically advantageous to announce that 154 programs would be eliminated or reduced, it becomes far dicier on Capitol Hill once they are identified.
"Given the impact of these cuts on average American working families, it is no surprise that the administration would want to hide them in the dark by slipping them under the door after the sun has gone down," said Rep. David R. Obey (Wis.), the ranking Democrat on the House Appropriations Committee.
You really have to watch these Bush people. What they can't get by bullying they try to get by stealth.