The Nefarious Big Bird- Health Care Connection

The flap greeting Mitt Romney’s cheerful admission that as president he’d defund Big Bird’s nesting place on public television could turn out to be good news for a federal agency promoting safe medical care that faces a similar extinction threat. But we won’t know till after the election whether the little-known agency benefited from Big Bird’s protective presence.

The stage was set for Romney’s Big Bird boast by a bill Republicans pushed through a House Appropriations subcommittee in July that slashed or eliminated budgets for a host of programs, including public television’s parent, the Corporation for Public Broadcasting. A committee statement at the time said the move was meant “to encourage CPB to operate exclusively on private funds.” That same bill completely abolished the Agency for Health Care Research and Quality (AHRQ).

Health policy wonks lamented that terminating the agency “would badly undermine important research on health care quality, disparities in care and patient safety,” as a member of AHRQ’s national advisory council put it. But hardly anyone else noticed.

The end of AHRQ didn’t even rate a separate mention in the committee’s lengthy press release. And while Politico reported that a Democratic subcommittee member called it “the only federal agency whose sole mission is to improve the quality, safety and cost efficiency of health care,” the subcommittee’s GOP chairman said, in effect, the death sentence was nothing personal. It was just a budget-balancing action and “not a reflection on anything.”

That’s where Big Bird waddles into the picture.

The health policy community has tried to tell itself that the AHRQ elimination vote was meaningless political theater, since there was no realistic chance the bill would be approved in anything close to its original form before the election. In the event, Congress finally did settle for a measure extending existing government funding for another six months. But that whistling past the graveyard ignores the bright flashing warning signal that Romney has reaffirmed.

Put bluntly, the GOP is expected to retain control of the House of Representatives. If the party is willing to kill Big Bird, despite the public image problem that presents, why would there be the slightest concern about axing AHRQ, an agency that even supporters acknowledge is a “rounding error” in the Department of Health and Human Services budget? In fact, cuts to programs like public TV and the Jobs Corps may even hurt AHRQ, since a Democratic Senate (if it remains that way) would be more likely to spend political capital on a compromise that saves higher-profile funding victims.

Naturally, if the Republicans add control of the Senate or the presidency, the AHRQ outlook worsens.

Romney made it crystal clear on national television that the reasoning used in the House subcommittee vote is an approach he embraces, not just a political gesture: “I love Big Bird,” Romney told presidential debate moderator Jim Lehrer, but then quickly noted he was not willing to “borrow from China” to subsidize public TV. Romney’s spending test is a legitimate effort to focus attention on what we, the American public, want our government to pay for as we seek to balance the federal budget.

But that effort should be driven by thoughtful consideration, not political calculation. If the National Institutes of Health’s $30.6 billion fiscal 2013 budget request is such an important investment that it goes untouched in the House subcommittee budget, is there a rationale other than political pique over “Obamacare” for eliminating AHRQ’s $0.4 billion budget entirely? (The actual request was $408.8 million, for those counting pennies.)

Now that Romney’s Big Bird budget has become a social media sensation, perhaps that’s a conversation we can finally have. Because the Americans harmed by unsafe care or overtreatment or undertreatment include Republicans, Democrats and those utterly indifferent to politics. They are young and old, rich and poor and even, many of them, members of the much-vaunted middle-class that both Romney and President Obama repeatedly vowed to protect. Heck, a few are even politicians (or their friends and family).

Of course, if none of this works for AHRQ, I have another suggestion for the agency, which has faced the threat of elimination or near-elimination on more than one other occasion: change your name and move to Sesame Street. Perhaps the third name change will be the charm.

Let me explain: originally called the Agency for Healthcare Research and Policy before an alert staffer noticed the “AHCRAP” acronym, AHRQ was created in 1989 as the Agency for Healthcare Policy and Research (AHCPR). It was nearly eliminated by the Newt Gingrich-led GOP House in 1995 as one more government agency meddling in the practice of medicine, but managed to survive with a change to the current name, an altered mission and a 20 percent budget cut.

So how do you get to Sesame Street? Clearly, AHRQ needs a more kid-friendly approach to fit in with its new neighbors. I suggest ABCD ­­– Adventures in Better Care Delivery.

And those nasty House Republicans? Well, when it comes to Big Bird, Oscar the Grouch is no match.

Michael L. Millenson is president of Health Quality Advisors LLC in Highland Park, IL; the Mervin Shalowitz, MD Visiting Scholar at the Kellogg School of Management; and a board member of the Society for Participatory Medicine.

4 replies »

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  2. So long PBS subsidies. But Big Bird will not go anywhere because there is no need for government help. Keep the government small is my motto, but with Obama care coming along, it seems almost impossible. Don’t know the answers just really worried. At some point, no matter what we are borrowing money for, no matter how lofty the cause, we won’t be able to keep doing it. THEN what happens. We all lose. Doctors, Nurses, and patients.

  3. Actually, Brian, the Sesame Street folks have said they do NOT need the subsidy, so you’re right. The larger point is what the government subsidizes. Government’s role is to invest in societal needs that don’t meet the private industry test yet may produce enormous societal and private enterprise benefits.

    So, for instance, AHRQ is to actual medical practice as NIH is to medical research.

  4. There is a significant difference between killing Big Bird and REMOVING the subsidy that the Federal Government provides to PBS. PBS will have to manage as other networks do – and adequately manage the money that they get in revenue from the plethora of Elmo Garb. If you are not commercially viable – then you are not too big to fail; or have we not learned that lesson well enough already ?