Reflections on the Budget Debate
September 7, 2011
J. Stephen Morrison
Senior Vice President, CSIS & Director, Global Health Policy Center at CSIS
The week after Labor Day, the Joint “Super Committee” of twelve Senate and House members begins its work on finding at least $1.2 trillion in spending reductions by November 23rd. The hope among many development and global health advocates is that the cuts will be “proportional and balanced.” The $917 billion in cuts, enacted in August for the next decade, were entirely “discretionary”and imposed significant caps on the future growth of foreign assistance. Congress steered clear of cuts in the domestically sensitive entitlements (social security, Medicare, Medicaid) that comprise the lion’s share of the U.S. budget.
In addition, this fall the Senate turns to the FY2012 foreign operations budget where, many hope, the Senate will correct the $5 billion in cuts previously enacted by the House Foreign Operations Appropriations Subcommittee (amounting to a 9% cut in global health and 18% cut in overall foreign aid.). Advocates hope that the Senate will establish a baseline roughly in line with current levels, holding funding steady for at least one year.
With these important budget decisions looming, the existential angst surrounding development and global health is palpable. The past decade’s heady expansion of these budgets has ended. The period of flat budgets is coming to a close. The big question is how far, how fast, and for how long the development and global health budgets will fall.
The Super Committee is an extraordinary historical phenomenon wrapped in uncertainty. It is, as one close observer commented, “big in every respect.” It possesses concentrated powers to put every account on the budgetary table simultaneously, massive and small; it is likely to carry out its work largely out of sight; and its time frame for action is remarkably compressed. The Committee will attempt to find a workable consensus in the midst of a highly polarized, partisan, embittered environment that will only grow more hostile as the Presidential race commences. The debate that resulted in this summer’s $917 billion in cuts failed to resolve what mix of revenue increases would be combined with spending cuts, and this deep divisive debate will now be carried forward. If $1.2 trillion in cuts are not achieved, the threat of automatic “sequestration” of accounts will ensue. Although half of the burden will fall on defense, all sectors will be vulnerable to further cuts.
No wonder there is utter confusion as to how the Super Committee will play out. No one knows whether valuable proven investments such as global health will survive without major damage. There is a real possibility that global health will be pitted against defense spending or domestic entitlements – a confrontation it is unlikely to win. In many ways, the Super Committee holds the power to decide whether U.S. leadership on global health will be preserved or gravely diminished.
There were earlier periods of budgetary cuts followed by recovery: in the mid-80s and mid-90s. Today looks different. The Super Committee could set a course that - for the next decade - exacerbates the caps already imposed in the $917 billion in cuts. Renewed economic growth, so essential to restoring budgetary balance and allowing an exit from rigid constraints, could be delayed for some time.
What to do?
An appeal to the principle of “proportionality and balance” makes sense, but is too ethereal to move most Americans or the Super Committee. More is needed.
Amidst this disorder, old habits of making the case for development and global health will not be very effective. If virtually all interests and accounts are on the table, an avalanche of anxious appeals will be directed to the 12 Super Committee members. In the resulting din, the cacophonous, fragmented pleas on behalf of individual foreign assistance programs will be lost. New habits, a different kind of messaging and strategy, are needed; though exactly what that means is still unclear.
To whom one turns for help is also uncertain. Many Congressional champions of global health are either retired or quiet in the face of serious challenges within their constituencies. The role of Committee and party leadership ranks in shaping the decisions of the Super Committee remains vague.
There is clearly the need to play “the inside game” more effectively, rebuilding a bipartisan core, while concentrating on a select pool of key Congressional figures such as Senators Kerry, Inouye, Murray and Graham. All but one are Democrats; Republican champions for global health have become scarce.
There is the need to make a broad and consistent, common sense argument that investments in development and global health are fundamental to U.S. leadership in the world, are rooted in our ethical and humanitarian values, and are tied to US national interests. Cutting these investments without addressing entitlement spending will do little to restore budgetary balance.
There is also the need to reignite the American faith community, which was so vital to the achievements of the past decade, but which has gone quiet as of late.
Perhaps most significantly, there is the pressing need for both former President Bush and President Obama to deliberately and publicly make the case for sustained American promotion of global health and development efforts. White House leadership, past and present, remain the sine qua non of sustaining US leadership in global health. President Bush needs to remind Americans and the Super Committee members why he felt (and continues to feel) so passionately about HIV/AIDS and malaria and why he moved the United States to make historic commitments that have sustained the lives of millions despite the perception at the time that these investments were not deemed “essential” to U.S. interests. For his part, President Obama needs to lead and negotiate in a way that makes visibly clear that he too passionately believes sustaining these American achievements has to be a national priority.
We will see a promising step in this direction when President Bush, former First Lady Laura Bush and Secretary of State Hillary Clinton appear together in Washington on September 13-14 to discuss the evolving global health agenda, including new priorities in maternal child health and cervical cancer, and to discuss U.S. leadership in HV/AIDS, malaria and TB. It will be President Bush’s first public appearance in Washington since leaving office in January 2009, and a signature inaugural event for the Bush Presidential Center. The timing is propitious.
The results will be even more fruitful if President Obama and Secretary Panetta overtly follow in making the case that investments in development and global health achieve strong results, are a ‘best buy,’ and advance U.S. interests. It was just a year ago that President Obama delivered the first presidential speech on a U.S. development strategy. In the midst of the current disorder, now is the time to deliver.
As always, I welcome your questions and feedback. Please leave your comments below.