A budget cutter with a conscience
ByMichael Gerson,Washington Post, Published: June2, 2011
British Prime Minister David Cameron has emerged as the most admirable of anomalies: the budget-cutter as leader of conscience.
If relocated to America, Cameron’s program of austerity would make him an unrivaled Tea Party darling. What serious American has made detailed proposals to cut spending in each government department by an average of nearly 20 percent during the next four years? Who would choose to simultaneously slash government jobs, social services and military spending?
The extremity of Britain’s fiscal crisis, of course, left few alternatives to budget-cutting ambition. Yet many British politicians have opted for less-responsible approaches. Cameron campaigned, won and generally has governed on a platform of fiscal discipline.
Still, Cameronism is defined not only by austerity but by a few notable exceptions to austerity. The prime minister has protected some spending categories from reductions,erecting what’s called a “ring-fence”around health programs and foreign assistance. This month, Cameron and Bill Gates will host aconference in Londonto encourage contributions to GAVI — theGlobal Alliance for Vaccines and Immunization. Britain will expand its commitment, and the country’sdevelopment secretary, Andrew Mitchell, has been twisting arms to persuade other governments to do the same. The increase that Cameron and Gates propose would vaccinate about 250 million children over the next four years, saving at least 4 million lives.
When I caught up with Mitchell by phone, he was visiting a GAVI immunization center outside Islamabad, Pakistan. “For the price of a Starbucks cup of coffee,” he said, “you can vaccinate nine kids. It is absolutely awesome.” Asked about opposition to foreign assistance increases while other spending is cut, he echoes words used by Cameron: “We’re not going to balance the books on the backs of the poorest people in the world. Charity begins at home, but it does not end there.” Reflecting on 25 years as a Conservative member of Parliament, he says of Cameron’s commitment: “I’ve never been so proud of anything.”
Cameron is equally passionate. At arecent news conference, he bristled at criticism of aid spending. “Of course it is difficult when we’re having to make difficult decisions at home. But I think that 0.7 percent of our gross national income, I don’t believe that is too high a price to pay for trying to save lives.”
This effort to expand vaccine coverage is important in itself. It also provides broader lessons for American politics.
Cameron is demonstrating to the Obama administration that it remains possible to set creative policy priorities even in a time of austerity. Increased support for GAVI came after an extensive internal aid review by the British government, which rated programs according to importance and effectiveness. GAVI and UNICEF came out well. Four others fared so poorly they were dropped from core funding entirely, including United Nations programs on development and labor rights. The case for aid effectiveness requires the recognition that some aid is ineffective. Budget constraints demand focus and measured outcomes. A systematic review and rating of American aid programs, similar to the one Cameron has conducted, would make it harder for Congress to refuse needed spending.
Yet Cameron, as the leader of a conservative party, also offers lessons to American conservatives. Responsible budgets are essential — inseparable from a commitment to limited government. But conservatism also involves a suspicion of abstract ideology and a concern for real-world consequences. The belief that some spending is wasteful while other spending is useful is not the evidence of inconsistency; it is the definition of political prudence. The refusal to draw such distinctions reveals a kind of ideological inebriation, making it impossible to display the fine motor skills of governing. Across-the-board spending cuts are as much an abdication of political judgment as across-the-board spending increases. Both are politics flying blind.
Cameron’s predecessor by a century and a half,Benjamin Disraeli, specialized in the politics of sophisticated distinctions. “I am a conservative to preserve all that is good in our constitution,” he said, “a radical to remove all that is bad.” He was a conservative reformer, who helped mitigate the suffering of the poor in a newly industrialized society.
Cameron is now forced to limit the most expansive, unsustainable commitments of the British welfare state. But he is showing Disraeli’s talent for making the distinctions that define a statesman.
In coming American elections, Republicans will require budget-cutting ambition. They will also need to show some judgment — and a humanity that could make all of us proud.
The real-world effects of budget cuts
ByMichael Gerson,Washington Post, Published: April 7, 2011
So far inthe budget debate, the Obama administration has drawn few bright lines, preferring to blur distinctions with concessions. But last week, a neon line was drawn by an unlikely administration official.Rajiv Shah, the administrator of the U.S. Agency for International Development, possesses the mildest of manners. Testifying before the House state and foreign operations subcommittee, however, Shah had this to say: “We estimate, and I believe these are very conservative estimates, that H.R. 1 would lead to 70,000 kids dying. Of that 70,000, 30,000 would come from malaria control programs that would have to be scaled back, specifically. The other 40,000 is broken out as 24,000 who would die because of a lack of support for immunizations and other investments, and 16,000 would be because of the lack of skilled attendants at birth.”
This is the hardest of hardball politics — accusing budget cutters of unwitting complicity in the deaths of children. House GOP lawmakers responded angrily. “Nearly every administration witness appearing before the Appropriations Committee,” saidRep. Jerry Lewis(R-Calif.), “has put forward nightmare scenarios and dire numbers to argue why we should not be reducing spending in any program. Republicans won’t be drawn into a debate over what might happen based on speculations and hype.”
But it is not realistic to take credit for cuts while forbidding a discussion of their consequences. Republicans were drawn into this debate when they proposed major reductions in foreign assistance, believing this category of spending to be an easy political target. Instead, they have stumbled into what one poet called “a problem on the borderline of ethics and accounting.”
By way of disclosure, I was an advocate in the George W. Bush administration for the creation of thePresident’s Malaria Initiative, designed to reduce mortality by half in 15 affected African countries. Most who die of malaria are children under 6 — several hundred thousand a year in sub-Saharan Africa. I recall one in particular — an infant, her head covered by a cloth, carried by her mother out of the gates of a hospital in Uganda, among the loneliest sights I’ve ever witnessed.
This background allowed me to see how anti-malaria programs are designed. The interventions — insecticide-treated bed nets, new combination drugs, indoor spraying — are neither complicated nor controversial. It is possible, with some accuracy, to determine how many lives will be saved at a certain level of spending. Which means it is possible to determine how many lives would be lost at a certain level of cuts.
USAID estimates that reductions proposed in the 2011 House Republican budget would prevent 3 million malaria treatments. Because the disease is misdiagnosed about half the time, this means about 1.5 million people in need of treatment would not receive it. About 3 percent of untreated malaria infections progress to severe malaria — affecting 45,000 children. Of those children, 60 to 73 percent will not survive, yielding 27,000 to 30,000 deaths. This does not take into account the 2.8 million children who will go unprotected by bed nets and insecticide spraying. Similar estimates can be made concerning cuts to immunization programs.
Despite Lewis’s claim, global health programs are not analogous to many other categories of federal spending, such as job training programs or support for public television. A child either receives malaria treatment or does not. The resulting risk of death is quantifiable. The outcome of returning to 2008 spending levels, as Republicans propose, is predictable.
Fiscal conservatives tend to justify these reductions as shared sacrifice. But not all sacrifices are shared equally. Some get a pay freeze. Some get a benefit adjustment. Others get a fever and a small coffin. This is not fiscal prudence. It is the prioritization of the most problematic spending cuts — a disproportionate emphasis on the least justifiable reductions. One can be a budget cutter and still take exception to cuts at the expense of the most vulnerable people on earth. In Britain, Prime Minister David Cameron is pursuing even greater austerity while increasing funding for development.
Cuts for global health programs should be of special concern to those of us who consider ourselves pro-life. No pro-life member of Congress could support welfare savings by paying for abortions. No pro-life member of Congress could support Medicare savings by cutting off life support for the sick. And it should give any pro-life member pause to support minuscule budget savings that risk the death of children from malaria.