Budget battle puts health spending in spotlight

At the vast National Institutes of Health complex in Bethesda, Md., scientists are cracking genetic codes for "all the potential bioterror threats." They're starting the first human trials for a vaccine for the Ebola virus and closing in on a new vaccine for smallpox that has "virtually no adverse events."

But they're also funding Bo Vine, a pert and peppy Holstein who headlines the "Milk Matters" Internet game, and a $1.2 million panda study in a nation that has no native pandas.

For self-styled "waste watchers" in Congress, the NIH's budget line - which has more than doubled in the past seven years - is a tempting target for cutbacks, especially in a year when Congress expects one of the largest deficits ever.

"The NIH does great work, but they still need to be accountable to the American taxpayers," says Rep. Jeb Hensarling (R) of Texas, who sees a tough fight on spending in this week's House budget debate.

The NIH is far from the only agency facing new fiscal scrutiny, but such comments are a sign of emerging tension over an area of government spending that has grown so rapidly for four decades that it cannot be avoided when Congress focuses on new spending restraint. Medicare costs have soared from $64 million in 1966, when the program was launched, to an estimated $422 billion in the 2009 fiscal year. A new report by the Social Security/Medicare trustees today is expected to project those costs significantly higher, due to revised 10-year estimates of the cost of the $395 billion prescription drug plan that Congress added to Medicare last year.

Those estimates of growth in entitlement spending put even more pressure on the discretionary side of the budget - including even NIH. No group, short of the Pentagon in wartime, has been as successful as protecting its budget lines on Capitol Hill as NIH. In response to a powerful lobbying effort by the scientific community and disease-focused advocacy groups, President Clinton and the GOP Congress committed to doubling NIH funding in five years, beginning in 1998 - a budget surplus year. NIH funding has increased more than 107 percent since then.

The growth coincides with healthcare's rising role in the nation's economic life - fast moving toward one-fifth of GDP.

"It all comes down to our concern for health. Since the mid-'80s, numerous groups outside the science community and the disease groups have lobbied quite strongly for increases in health funding," says Kei Koizumi, head of the R&D budget and policy program for the American Association for the Advancement of Science.

But amid record deficits and a new scrutiny of by lawmakers, President Bush requested $28.6 billion for NIH in the 2005 fiscal year, a 2.7 percent rise over the previous year.

"We knew there would be a landing after doubling NIH budgets, but we had hoped for a softer landing. To go from 15 percent increase to 3 percent is not a very soft landing," says Joanne Carney, director of the Center for Science, Technology, and Congress for the American Association for the Advancement of Science.

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