How much of the big political and legislative picture should we be concerned with when we advocate for more federal funding for cancer research? Funding for myeloma research? Cancer research? Medical research? The congressional appropriations process? What about tax cuts?
I have made the point numerous times in previous Myeloma Today articles and discussions with many IMF members around the country: if we are serious about achieving the goal of more federal funding for myeloma research, we must advocate on behalf of all cancer research funding. Specifically, we must be active in coalitions like One Voice Against Cancer (OVAC) to support full funding for the National Institutes of Health (NIH) and educate our members of Congress about the National Cancer Institute (NCI) Director’s Bypass Budget. It is only by working with others with similar goals that we will achieve our specific goal of more funding for myeloma research.
During our most recent OVAC Advocacy Day in June 2002, however, I was strongly advised by one member of Congress and other staff members that advocating for a bigger slice of the funding pie for NIH and the Bypass Budget overlooked another stark reality. It was not enough, according to these individuals, to ask for more funding. In fact, it could be counterproductive in the long term.
What was needed, they argued, was an understanding and appreciation of how the political and appropriations processes were dependent on each other. How, for example, could the appropriations committees begin to fulfill the wishes of the competing funding constituencies if tax cuts diminished federal resources by $600 billion?
Under these conditions, no constituency should expect to fulfill their wish lists, or, in a more likely scenario, the future of appropriations would translate into a process of perceived winners one year becoming losers in the next. For example, this year, it seems likely NIH will achieve or come near to the five-year doubling pledge goal of $27.3 billion.
That might translate into education programs not being funded at the levels promised in previous years. It also may translate in reductions or stagnant funding levels for other health programs such as the Health Resources and Services Administration (HRSA) or the Centers for Disease Control and Prevention (CDC).
And in boom-and-bust funding cycle scenarios, it may mean that next year's medical research funding figure will barely rise while other programs, the perceived losers of the current cycle, will experience greater increases. It will be the legislative metaphor of moving around the deck chairs on the Titanic.
What is the subtext to this debate? Part of the answer, in a case made strongly to me by one member of Congress, is if we are vocal about increasing funding levels for NIH and NCI, we should also be vocal and concerned about tax cuts limiting the funding streams for those agencies. The two are related.
This argument is one component of the historic political tensions that have underscored the American political process. But instead of “guns or butter” the mantra for advocates may be “tax cuts or cancer research” or “tax cuts or education funding.”
On the other side of the discussion, there would be no guarantee that research funding would automatically go up if tax cuts were defeated and the federal funding stream remained uninterrupted. Those decisions would again be left up to the various appropriations subcommittees and there are no guarantees that link tax income with funding for programs.
The moral of the story is that advocates must be vigilant and assertive no matter the political environment. We should always vigorously support our goals. We shouldn’t take for granted success in the good times. Nor should we expect lesser results in tight fiscal times.
But we should expect winners and losers in the appropriations process. Although the NIH part of the equation looks promising for cancer research advocates this year, the other parts do not look as promising. The outlook for the next few years is even more nebulous, especially for NIH.
And remember to connect the dots. At least then it is easier to explain the final results. And remember that it is more likely to be on the losing side of the appropriations process when the income of the federal government is constricted by tax cuts.