Obama healthcare: Government, heal thyself
Even at a time of high-profile budget cutting, the Obama administration is spending not just on the essentials of governance but also on social engineering to promote its liberal inclinations.
One example is the Department of Health and Human Services announcement in May of the availability of $100 million for “community transformation grants,” a program created by “Obamacare.”
The Centers for Disease Control and Prevention will administer the program, and grants will be funneled to local government agencies and nonprofit organizations, which are required to use evidence-based strategies and ensure that their activities have broad population impact and help address health disparities. Projects that could qualify include the promotion of blood pressure and cholesterol screenings, increased access to healthful food options, including the elimination of food deserts (areas where it is supposedly difficult to buy healthful foods), and efforts to improve school nutrition and bring more healthful foods to corner markets in urban areas.
The new grants “will empower communities with resources, information and flexibility to help make their residents healthier,” according to Secretary of Health and Human Services Kathleen Sebelius. And this presumptive improved health will result in — wait for it — savings in federal healthcare expenditures because of less chronic disease caused by tobacco use, obesity, poor diet and lack of physical activity.
These are worthy goals, but we would argue that this wishful-thinking, ideological approach to achieving them is especially dubious at a time of budgetary belt-tightening.
An examination of how the CDC has doled out funds under a similar program shows that funding decisions are based more on ideology and intuition than evidence. This program, Communities Putting Prevention to Work, or CPPW, also funded by Obamacare and administered by the CDC, comes from a pot of $500 million this year, increasing to $2 billion by 2015 and thereafter, and funded in perpetuity until Congress decides to drive a stake through its heart. The CPPW ostensibly requires “evidence-based strategies” to fight tobacco use and obesity.
However, most of these CDC-administered social engineering programs are not based on evidence. In fact, in some cases, the evidence shows that the projects don’t work. For others, there simply isn’t evidence that they are effective because the interventions haven’t been studied, making these extremely expensive experiments at best.
Here are some examples of how the funds in the CPPW program are being used:
•$15.8 million to Pima County, Ariz., for ensuring that “residents have improved access to affordable, healthy, locally produced food through the fostering of private and community gardens, composting cooperatives, farmers markets and food cooperatives.” But there is no evidence that such efforts change eating habits. Given that, using federal funds for community gardens and composting is the agricultural equivalent of congressional earmarks such as the infamous “bridge to nowhere” in Alaska.
•$15 million to Philadelphia to “make healthy foods more available and affordable by dramatically expanding the number of farmers markets in low-income neighborhoods and by creating 1,000 healthy corner stores that sell fresh produce and water. Unhealthy foods will be removed from school stores and fundraisers, and a citywide pedestrian and bike plan will be completed.” Whatever they call it, this is a federal welfare program. And like other federal welfare programs, it will be prone to rampant corruption, abuse and fraud. We will see more pedestrian paths where people don’t walk and bike lanes where people don’t bike.
•$6.1 million to Boston for anti-tobacco campaigns. A portion of these funds is going to an anti-scientific, bizarre and secretive campaign to ban the use of e-cigarettes where cigarette smoking is banned. E-cigarettes are tobacco-free, smoke-free devices that use vaporized nicotine to replicate the experience of smoking cigarettes. There is no evidence to suggest that e-cigarettes are any more dangerous than the nicotine gum or patches that the FDA has deemed safe and effective. A ban would create a gratuitous obstacle for people who are trying to quit smoking cigarettes. And if that isn’t troubling enough, the Boston Public Health Commission, which received the grant, and the CDC have repeatedly refused to disclose any scientific basis or rationale for the ban. So much for transparency and responsible governance.
Interventions that confuse plausibility with provability or that fly in the face of peer-reviewed evidence are themes that run throughout such social engineering programs. The requirement that chain restaurants post calorie counts on menu boards, for example, isn’t the most disruptive of policies, but studies show it isn’t effective. In one published in the International Journal of Obesity in February, NYU School of Medicine professor Brian Elbel and colleagues studied receipts from inner-city kids who ate at restaurants with the menu boards before and after calorie counts were required in New York City, as well as from kids in Newark, N.J., where calories were not posted as prominently. The study, funded by Yale, the liberal Robert Wood Johnson Foundation and the National Institutes of Health, found that calorie counts did not affect kids’ choices.
Another aspect of these programs deserves comment. In government, personnel choices are tantamount to policy choices, and the person appointed by President Obama to decide how to spend billions of dollars of these highly discretionary funds, CDC Director Thomas Frieden, is a terrible choice.
Frieden may be passionate about making us healthier, but his approaches are extreme, paternalistic and unproven. As commissioner of public health in New York City, he treated city-dwellers like lab rats, experimenting with a ban on trans-fats and even a campaign to reduce the amount of salt chefs can use in the city’s vaunted restaurants. What was the legacy of his trans-fat campaign? As Jeff Zeak, a researcher at the American Institute of Baking, said: “When you have a fat that doesn’t contain trans [fat], it’s typically going to be higher in saturated fats.”
The Obamacare social engineering grants programs probably have a great future. As economist Milton Friedman used to say, “Only in government do we see something that doesn’t work and decide it needs to be expanded.”
Jeff Stier is a senior fellow at the National Center for Public Policy Research and directs its Risk Analysis Division. Henry I. Miller, a physician, is a fellow at Stanford University’s Hoover Institution. He was the founding director of the FDA’s Office of Biotechnology.