Federal Investment for Public Health--or for Endless Wars?

The current coronavirus pandemic lays bare the distressing choices that have been made by our elected representatives, and by extension by the voters, in past years. Rather than invest in the needs of the public, our leaders have chosen to allocate more than half of the Congressional discretionary budgets to military priorities, weapons manufacture, and upgrading of nuclear weapons, which do not serve medical or public health needs.

The House of Representatives vote on March 27th for the CARES Act to cope with the coronavirus outbreak was a step in the right direction in cushioning the economic blows of the coronavirus outbreak. The direct response to containing the outbreak certainly requires expanding existing healthcare facilities and building new ones; increasing healthcare staffing; ensuring health care providers have an abundant supply of masks, gloves, gown, and ventilators; raising the wages of frontline healthcare workers; and ramping up testing at no cost to those tested. In addition, we need to address the glaring inadequacy of our current public health system which has suffered repeated cuts in funding, especially during the present administration. We need an integrated system where one state is not battling others for much-needed equipment, where we are collecting data to get a clear picture of where our efforts are best spent. This and many other tasks should be the work of our public health system.

Congress continues to finance expensive new weapons, rather than be informed by the long-term health and welfare needs of our populace.

But the more than $700 billion authorized by Congress for the costs of foreign wars, maintaining 800 military bases around the world, unnecessary weapons purchases, and the provocative nuclear weapons upgrades, remains untouched. Congress continues to finance expensive new weapons, rather than be informed by the long-term health and welfare needs of our populace.

Successive administrations have abolished the very offices that could have provided us with the tools that we need to fight this pandemic and others. The White House Pandemic Office has been abolished during the current administration. Preceding administrations had begun efforts to provide for biodefense only to shutter these offices once the threat of the time was considered over. But there will always be a new threat and we will continue to be unprepared unless we heed the lessons provided by the new coronavirus.

Thus, in addition to basic health care for all and a well-funded, functioning system that addresses epidemiological needs, basic and biomedical research capacities are needed to understand the biology of the infectious agents themselves, how they interact with human cells, how they infect cells, and how they reproduce. Critically important facilities include labs where these issues can be studied. We need not only the labs with their x-ray diffraction equipment, cryo-electron microscopes, nucleic acid sequencing machinery, and powerful computers but the trained personnel who can use these tools. None of these biomedical resources are paid for by Medicare, Medicaid, private health insurance or hospitals. For the most part, they depend on Congressional appropriations of our tax dollars to the National Institutes of Health (NIH), the National Science Foundations (NSF), the Department of Energy and some smaller agencies. Any capacity to respond to the current virus is directly due to investments made in these agencies. It is clear that current investments are not adequate to deal with any pandemic. As an example, once it became clear that the SARS epidemic was under control in 2003, the nation failed to invest the sums needed to develop a SARS vaccine. Had that been done, we would likely have been better prepared to counter the CoV-19 coronavirus strain, a cousin of SARS.

Each of the budgets that President Trump has proposed to Congress included significant cuts to NIH and NSF, as well as inadequate sums for allied agencies such as the CDC. His rationale for these cuts has been a claimed need for increasing the already bloated Pentagon budget, $738 billion last year, about 55% of the federal discretionary budget. In contrast, NIH - responsible for the development of prevention, therapies and cures for all the ailments that afflict our people, such as cancer, heart disease, stroke, Alzheimer's, Parkinson's, and diabetes, to name a few - was about $40 million, about 3.7% of the discretionary budget.

In contrast to the President's initially lukewarm response to the need for federal interventions, the CARES Act directed about $1 billion to NIH, $4.5 billion to the Centers for Disease Control and $3.5 billion to the Biomedical Advanced Research and Development Authority. These outlays may appear to be generous sums given the previous almost austerity budgets for these agencies. However, let's compare these sums to the $70 billion supplementary Pentagon budget Overseas Contingency Operations (OCO) appropriation to support our wars abroad, widely viewed as a slush fund for defense contractors, or the approximately $100 billion appropriated for new nuclear submarines and their nuclear-tipped missiles.

The CARE Act funds will save thousands of lives, while the $70 billion OCO will certainly lead to the continued deaths of both members of the military and the civilians in the Middle East, where the wars are primarily civil wars in which the US is intervening. They do not involve the defense of our shores.

It's instructive to compare the $42 billion initially appropriated for NIH last year with the $738 billion national defense appropriation. Consider Alzheimer's disease, one small part of NIH's responsibilities. The care of these more than 3 million patients alone account for 20% of Medicare's and Medicaid's budgets, over $250 billion a year. Yet the overall NIH investment in searching for a deeper understanding, better diagnosis, and better therapies is on the order of $1 billion per year, clearly an inadequate investment given the human suffering and social and economic costs of the disease. For a social cost of $250 billion, perhaps 10% of that would approach an adequate investment. There are alternatives to our skewed priorities. As one example of where the money can be found, the adoption of Senator Ed Markey's Safer Approach to Nuclear Expenditures (SANE) Act would lead to an immediate saving of $75 billion in nuclear weapons spending, money that could be used for pressing health needs.

The current pandemic highlights faults in the entire U.S. health care system, from basic research into various diseases, the development of cures and preventative measures, continuing through to the actual delivery of care to patients. It has been obvious to many that the nation needs significant reform in health care funding and in the delivery of health care so that all in the U.S. have access to health care without financial impediment. The current patchwork of insurance policies, private, for-profit hospitals, and uninsured patients prevents the application of the fair and systematic policies and procedures that are needed to confront the spread of infection and to care for those infected. One needs only to look at the Pentagon budget to find a ready source of funding for basic human needs.