If all goes according to President-elect Donald Trump’s plan, the next Secretary of the Department of Health and Human Services (HHS) will be Rep. Tom Price. While Price is perhaps best known for his opposition to the Affordable Care Act, the Georgia Republican has long beat the pulpit for spending and budget control, saying in 2015 that the $18 trillion national debt is “literally…choking off the actual vitality of our great country.” Much of the hand-wringing about Price as the nominee for HHS has focused on the fear that he will “cut funding” to health programs many feel are essential for the well-being of the country. Of course, as Secretary, Rep. Price would have less control over the size of HHS’s budget than he did as Chairman of the House Budget Committee. Budgets are the purview of Congress—not cabinet secretaries. What Price can do and that might have a more lasting effect, is to rein in “mission creep.”
Take for example, the Centers for Disease Control and Prevention—an agency within HHS. Founded in 1946, the primary purpose of CDC (then called the Communicable Disease Center) was to address the problem of malaria—the dreaded mosquito-borne disease that was, until after World War II, rampant in the southern United States. Two years later, malaria was considered “eradicated” in the U.S. (thanks mostly to the use of DDT) and the agency turned its sights on other infectious diseases. In the intervening six decades, however, CDC has turned further away from its primary mission of monitoring and treating diseases spread between animals and humans and has dedicated an increasingly large portion of its budget for chronic conditions, particularly those influenced by individual lifestyle choices, like obesity, diabetes, and tobacco-related illnesses.
Few would argue about the good work that the dedicated men and women at the CDC do and the importance of all the diseases and conditions that they address. However, as the scope of conditions that the agency focuses on broadens, the wider its efforts are spread. The more it focuses on a condition like heart disease, the less it is able to concentrate on the diseases for which it was founded. And as a result, we are less prepared for events like the Ebola outbreak that took the CDC by surprise in 2014. While many observers in and outside of Congress asserted that the reason for this lack of preparedness was that the agency was underfunded, its budget had nearly doubled from $3.5 billion to $6.8 between 2000 and 2014.
The problem isn’t that the agency didn’t have enough money, but that they spent their money on too many things outside of their original mission of preventing and treating communicable diseases. Of the $11 billion allocated to CDC for fiscal year 2015, the agency spent just more than 20 percent on diseases transmitted by humans and animals. The rest went toward a myriad of other projects and costs. Arguably, some of these efforts are useful projects to prevent chronic illnesses, but others, like the recent tone-deaf campaign compelling women of child-bearing age to abstain from either booze or unprotected sex, are of questionable value to the taxpayer.
While the CDC is a good case study in mission creep, as George Mason University’s EconoStats detailed in a recent report, it is far from the only or even the largest example of waste within HHS. The National Institutes of Health has an even larger budget at more than $31 billion in fiscal year 2016. More than half of that is dedicated to funding research proposals and grants, making NIH the single largest funder of medical research (although pharmaceutical companies collectively give more at around $37 billion). As with the CDC, the research that NIH funds are topics which most Americans would certainly agree are worthy of study. Unlike CDC, the NIH is tasked, not with preventing diseases, but with studying the causes and treatment approaches to diseases and communicating their findings to move scientific understanding forward and inform public policy. The problem is that, in recent decades, NIH has moved beyond mere research into the realm of advocacy.
While the NIH has explicit ethics policies against using government funds to lobby, that hasn’t stopped the agency from funding research that it knows will support a particular narrative. Echoing CDC’s “abstinence” on alcohol policy, NIH has been increasingly funding research that seems to show only negatives with alcohol consumption at any level, such as a 2013 study published by the American Journal of Public Health, which purported to show alcohol-attributable cancer deaths at all levels of alcohol consumption. In addition to using questionable methodology, the study failed to account for the repeatedly demonstrated cardiovascular benefits associated with light to moderate alcohol consumption. While this single study doesn’t show bias, an examination of how—and more importantly to whom—NIH distributes research grants demonstrates a disturbing pattern.
The aforementioned study was funded by an NIH grant awarded to Dr. William C. Kerr of the Public Health Institute. This grant is only one of 30 grants given to Kerr since 2005, totaling almost $11.5 million. One of his latest works, a study meant to examine the effects of Washington state ending its monopoly on liquor sales in 2011, was little more than “opposition research.” Kerr and his team had a polling firm call approximately 1,200 Washington residents two years post-privatization to ask them a variety of questions, including whether they’d change their vote on privatization. While 1,200 is a far smaller number than the 2 million voters who cast ballots in 2011, and despite the fact that respondents overwhelmingly thought privatization had been a success, the press release Kerr’s team wrote focused on the fact that 20 percent of those polled who originally voted for privatization indicated that they’d change their vote (as opposed to the 4 percent of those who voted against privatization and would change their vote).
The focus of the press release isn’t surprising, considering that Kerr sits on the board of advisors for the National Alcohol Beverage Control Association (NABCA). NABCA is an organization devoted to protecting those state alcohol monopolies, and a group for which Kerr and his group have received money to write papers and for “contracts and travel support.” What is surprising is that NIH continues to give Kerr millions in research grants to produce, not pure research, but what appears to be propaganda or—at least—research on how best to produce propaganda and lobby local governments to maintain liquor monopolies. As indicated in a 2014 paper, he appears not to just be interested in finding out how alcohol and alcohol policies affect health, but in determining the best strategies to “increase popular and political will for enacting alcohol policies” and optimal ways to “affect decision makers and legislators.”
Nobody is going to argue that alcohol abuse, obesity, or heart disease aren’t terrible conditions that affect millions of Americans and cost our healthcare system money. Furthermore, it’s worth noting that the work CDC does and the work researchers like Kerr and his colleagues do with the support of NIH is valuable. The problem, however, is that their work falls outside of the mission of their agencies and the more that happens the fewer resources are available for the agencies’ primary purpose. As Secretary of Health and Human Services, Rep. Price has no say in how much money his agencies receive from Congress. By reining in what the agencies do, however, he can limit how much money they need to operate. Price could simply abandon certain programs that statute leaves up to the Secretary’s discretion, but that would last only as long as Republicans control the White House: the next administration’s appointment could simply reverse course. If Price wants to effect lasting change and efficiency within HHS, he should be begin by shifting how it spends its money. By reversing decades of mission creep and refocusing agency efforts on their primary purposes, Price has a chance to not only eliminate out-of-control spending, but to make our agencies more effective at understanding and preventing disease.