Academic journal article Health and Social Work

Of Technological Targets and Budgetary Bombs: The Dangers of Depersonalized Budgetary Warfare

Academic journal article Health and Social Work

Of Technological Targets and Budgetary Bombs: The Dangers of Depersonalized Budgetary Warfare

Article excerpt

It seems any politician these days can become a policy expert by simply applying a user-friendly statistical software package, a spreadsheet program, and a graphics package to a public budget. One simply draws the projected spending trend lines to converge or diverge according to the desired political objective by asking a series of "what if" questions like, "If we can save $10 billion a year by paying less for a particular benefit, what does that do to the slope of the projected rate of growth of program spending?" Budgetary analysis becomes a search for the rate of growth that attains the prespecified spending target (Hadley, 1995). In this "purely objective" process, the purposes for which revenues are spent are virtually irrelevant, as are the beneficiaries. It reminds me of a young state legislator I once knew who, on being provided information regarding the effects of the cuts he was about to adopt, covered his ears and spat out, "Don't confuse me with more facts."

This year's dispassionate search for spending "targets," juxtaposed against this summer's escalating rhetorical warfare between Democrats and Republicans over the future of Medicare, coincides ironically with media coverage of the anniversary of the atomic bombing of Japan. Such gratuitous target and warfare allusions all but merge in re-reading John Hersey's (1946/1955) harrowing description of the stunned innocent victims of Nagasaki and the elated naivete with which Americans greeted this tragic but transformative event. The high-tech damage wrought was anything but impersonal.

At issue now is similarly insidious and unfathomable destruction, the congressional budget cuts aimed largely at poor people. The Republican leadership, after claiming a mandate last January, set for itself the most forceful agenda since the New Deal - to shrink government and balance the budget at all costs. And by August 11, when with great relief advocates saw Congress finally recess for the summer, their Contract with America had begun to take the form of the fiscal 1996 budget. The budget resolution adopted in both houses last spring calls for $530 billion in cuts over the next seven years, including $182 billion in cuts to Medicaid and $270 billion to Medicare, plus $245 billion in tax breaks (mainly for the wealthy) and an increase in military spending, to be paid for largely with these and additional cuts to health and human services. Unable to agree by summer's end on basic details about how to accomplish this, Congress has put off the bloody battle until September; consensus needs to be reached by the fiscal year's start date, October 1, although few expect it will.


The following are some of the health-related "lowlights" from the fiscal year 1996 budget discussions thus far. In most cases the spending targets set by Speaker Newt Gingrich (R-GA) and his gang of hungry freshmen in the House are more drastic than those agreed to by the Senate (where posturing by several presidential candidates has thus far nonplussed Senate Majority Leader Robert Dole, R-KS). This information, unless otherwise referenced, was gathered through Handsnet, an on-line information service posting notices for community-based organizations and advocates. The list begins with the biggest and most contentious items, Medicaid and Medicare, and works down to the "small ticket" items already passed by the House or its committees. Many items could still be changed by the Senate.


The most pernicious of all the reductions in the budget resolution time bomb is the $182 billion in Medicaid program cuts to occur over seven years, of which the American Health Care Association estimates $68 billion will be cut from long-term care services. The proposal restricts program growth to about 4 percent a year, regardless of economic downturns, population growth, or other unforeseen conditions that could precipitate Medicaid demand. …

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