Thursday, November 26, 2015

Sen. Bob Casey on NIH funding and the problem of balance in health-care spending

Pennsylvania Sen. Bob Casey says he spends a lot of time pushing for funding of the National Institutes of Health because it translates into jobs in Philadelphia and other parts of this region.

Sen. Bob Casey on NIH funding and the problem of balance in health-care spending


  Pennsylvania Sen. Bob Casey says he spends a lot of time pushing for funding of the National Institutes of Health because it translates into jobs in Philadelphia and other parts of this region.

"There is bipartisan consensus, less so on financial levels, but we're not as far apart as we are on other issues," Casey said in a meeting Friday with Inquirer reporters and editors. "I focus on [NIH funding] for a couple reasons. No. 1 is because this region of the country has made great progress but also there is no region more at risk than Southeastern Pennsylvania because of the dollars the state gets."

A Scranton Democrat, Casey said breakthroughs in medical and life sciences research happened in Philadelphia and the surrounding area because of expertise, but also because NIH funding helps pay for the expertise.

Pennsylvania got about $1.46 billion in NIH funding in fiscal year 2012, the last year for which figures were available. That was the fourth highest total among states. Pennsylvania's first and second Congressional districts, which encompass much of Philadelphia, got 1854 of 3,369 NIH grants, worth about $806 million of the total amount for the state.

"What has put it at risk is not sequestration, though that is a factor, but even in the absence of sequestration, just the fight every year to keep funding levels where they are," Casey said. "If you analyze it with inflation, it has been going down every year since 2003. The last four fiscal years, it has ranged from $30.3 billion to $30.9 billion, but over time with inflation that brings less in research."

Casey noted that the late Sen. Arlen Specter managed to also push an extra $10 bill into the recovery legislation in 2009.

Medical and pharmaceutical research often takes decades to produce results. (People from various sectors with various interests argue that it should be quicker, more efficient and less costly, but we'll leave that debate for another day.) A renewal of the farm bill is pending in Congress and farm bills usually go for five years. The basic idea is that farmers need time to plan, plant and grow crops, so turning funding switches on and off on a yearly basis does not work. (We'll also leave the many criticisms of farm policy for another time and place.)

We asked Casey if it makes sense to put scientific research funding on a similar, five-year funding track?

"That is something we should consider, having a longer duration to have some predictability," Casey said. "We haven't done this very well. Even with the long list of tax strategies or tax credits for clean energy, folks say, 'Thanks for the tax credit, but it's only for one year.' That is also true for medical research."

Casey voted for the Affordable Care Act, which is meant to bring basic medical care to more people but also start to bring down the cost of health care, which now accounts for about 18 percent of gross domestic product. But one of the ways to pay for that expansion of care was to tax medical device companies 2.3 percent on the sale of a device. Casey voted to repeal that tax after hearing many complaints from Pennsylvania medical device companies and their lobbyists.

If every Senator or Congressman voted to repeal any tax that directly impacted an industry in her/his region, would the government ever have enough money to operate? Where is the balance?

"For me, it was a reversal," Casey said. "I spent a lot of months listening to our folks in the state. One of my responsibilities is to fight for jobs in our state and this would be detrimental in terms of the jobs issue. No. 2, it would be like medical research and competitiveness, regarding devices and how we treat people. That is, are we losing our edge? But I don't want to walk away from the idea of trying to protect Pennsylvania jobs. When you remove something and pay, you've got a [funding] gap. That is an issue."

As Casey noted, life sciences research is a "big jobs issue and they are high-paying jobs."

Fiscal conservatives like to point to welfare cheats as examples of government waste. But another form of government welfare is money channeled through NIH to academic institutions and for-profit companies doing research that leads to high profits and high-paying jobs. But almost all of those organizations - hospitals (including non-profits with highly-paid executives), drug companies and doctors - rely on government payments to treat people through insurance programs such as Medicare, Medicaid and Tricare. The Medicare Part D drug program helps seniors pay for medicine and Republican President George W. Bush was happy to claim credit for its passage while he was in the White House, but he did not push through any taxes to pay for it.

Some patients add to this national conundrum by thinking that health care should be free to them without any taxes or fees, but want "waste" eliminated somewhere else.

Is it hard to have it both ways, Casey was asked?

"I don't think we're close to finding that kind of balance," Casey said. "We also have to be open to some ideas. I have heard Republicans say they want some reforms. They have questions about research grants and what happens. There is room for debate about where the money goes, the bang for the buck or the effectiveness of the the investment. But if you listen to people like [NIH director] Francis Collins, you realize you're listening to someone who knows so much about medicine and potential for breakthroughs. We have so much potential but yet that potential is restrained or held back by these funding issues."


Inquirer Staff Writer
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About this blog
David Sell blogs about the region's pharmaceutical industry. Follow him on Facebook.

Portions of this blog may also be found in the Inquirer's Sunday Health Section.

Reach David at or 215-854-4506.

David Sell Inquirer Staff Writer
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