At HHS, Nowhere to Go But Up

If ever there was a part of the Washington bureaucracy that has nowhere to go but up, it would be the Department of Health and Human Services. Last year, HHS was the centerpiece of the Obama administration’s efforts to show that it could be just as big a budget-cutter as any Republican White House, not for a moment sparing the most vulnerable. In some ways, it succeeded.

HHS administers a host of programs that aren’t well known to most Americans but that are vital to poor households. Obama’s 2013 austerity budget called for cutting the Low Income Home Energy Assistance Program, reducing immunization programs for the low-income and uninsured, slashing graduate education funding for children’s doctors and eliminating of the Preventive Health and Health Service Block Grant. The latter is an especially valuable way to shift the focus of U.S. healthcare toward prevention and wellness—something that’s just considered rational in most industrialized countries.

All of these are cuts that Americans will find themselves paying for sooner or later in the form of privation and worse health care for the poorest. In addition, we’ll be dealing with the consequences of continuing woeful underfunding of vital services like foster care and other child care, HIV/AIDS prevention programs and home-based care for seniors.

So where do I go from here, as secretary of HHS? First, a word of definition. Outside of Homeland Security, HHS is the biggest mishmash of programs and services in the federal government. Another way to think of it is Medicare, Medicaid and everything else. Medicare makes up 56 percent of HHS’s budget, Medicaid 30 percent, and everything else — from Indian Health Services to HIV/AIDS — 8 percent. It’s that last 8 percent that always takes the brunt of the budget cuts.

As secretary, I’ll push aggressively to allow State Innovation Waivers for ObamaCare by 2014, rather than 2017, so that Vermont and other states that choose to follow its lead can move ahead with single-payer alternatives to the “market-based” solutions embodied in the president’s healthcare law. I’ll go to the people to make clear the long-term cost of the program cuts that the administration pushed for HHS in 2012. And I’ll fight Republican efforts to turn Medicaid into a block-grant program that state governments can then manipulate away from its focus on helping the poor and working poor.

HHS is probably the most vilified set of programs in government, used over and over by conservatives looking for cheap ways to assert that poverty programs breed poverty or that government is trying to use these programs to create a society of welfare dependency. Most HHS secretaries in recent decades have just tried to keep their heads down and avoid controversy. I’ll take a different route. I’ll expose Republican efforts to censor scientific research at the Centers for Disease Control, to keep contraception unavailable, to exempt certain states from the universal coverage requirements of ObamaCare and to keep end-of-life planning from being covered as part of Medicare. Among many other things.

This might seem less than overwhelming — good policy, but nothing more. But the conservative culture war on social services doesn’t usually take the form of out-and-out assaults on big, universal programs like Medicare. Instead, it consists of attacks on parts of these programs, and on more modest programs, usually in the name of religious freedom or family values. Often these are inaccurate, such as Mitt Romney’s campaign-trail accusation that Obama wanted to “gut” work requirements for federal welfare programs. But the point is to deny the validity of any solution to social problems that can be described as collective or cooperative — even when it’s run by government and even when the private sector makes a profit from it, as with Medicare and much of ObamaCare.

The first duty of the secretary of HHS has got to be to publicly, aggressively fight back against these attacks, making clear that the work of HHS is vital to maintaining a civilized society and throw the conservatives’ real agenda back in their faces — to cut anything and everything that poses any threat to the low-tax, low-wage economic regime they’ve built for themselves. Should the President prefer that I avoid controversy and leave this fundamental issue alone, my course is clear—I will resign.

Eric Laursen is an independent journalist based in western Massachusetts. He’s the author of The People’s Pension: The Struggle to Defend Social Security Since Reagan.