3 Thoughts On the White House Budget Request

The White House released its 2013 budget request. What this means for the US-UN relationship, global health priorities, and the legacy of Hillary Clinton.

1) From the perspective of those of us who value a strong relationship between the United States and the United Nations…so far so good. The budget request includes slight increases to the account that funds American contributions to UN peacekeeping and the “Contributions to International Organizations Account” which includes American dues to the regular (non-peacekeeping) UN budget. This later figure is $567.931 million  If enacted as is, the president’s budget would mean that the United States is paying its fair share of the UN budget and UN peacekeeping operations. Of course, that’s a big “if,” — Congress still has to take a whack at this —  but the White House deserves praise for demonstrating its value for a strong US-UN relationship.

2)  The White House requests $7.9 billion for the Global Health Initiative. This figure, however, is something of a mixed bag. It includes a decrease for PEPFAR (USA’s signature global HIV/AIDS program) from $7.154 billion last year to $5.4 billion this year. Perhaps anticipating criticism from the activist community, Global HIV/AIDS Coordinator Amb. Eric Goosby wrote a lengthy post on the State Department’s blog defending this move. He argues that the cut is justified, in part, because PEPFAR is meeting its targets AND succeeding in driving down costs of HIV prevention and treatment.

Under this Administration, PEPFAR has matured. We’ve become more efficient, increasing the impact of our work. The FY 2013 request reflects this focus on finding efficiencies and continuing to drive down costs. By using generic drugs, shipping commodities more cheaply, task-shifting to nurses and community health workers as appropriate, and linking AIDS services to other programs (such as maternal and child health), we have dramatically decreased the per-patient cost of providing treatment and other services. We have reduced PEPFAR treatment costs per person from $1,100 to $335 per person and costs continue to fall — every dollar we invest is going farther.

It is also worth pointing out that the White House did not waiver from its commitment to fund the Global Fund to Fight AIDS, TB and Malaria. The White House request for $1.65 billion keeps it on track to meet a commitment to give $4 billion over 3 years to the Global Fund.  The big global health shift, as it were, is from bi-lateral programs (which are mostly financed through PEPFAR) to the multi-lateral Global Fund. I’m agnostic on the cuts to PEPFAR (I don’t know exactly what they entail) but the White House deserves praise for keeping its commitment to the Global Fund–which has been a very effective vehicle to fight HIV/AIDS, TB and Malaria worldwide.

I wish we had money to do it all. Or, rather we would have money to do it all if foreign affairs amounted to more than 1% of the Federal budget. Still, this budget looks decent for now.

3) This will be the last foreign affairs budget request in which Hillary Clinton is Secretary of State.  At a time when other agencies are seeing their budgets slashed or flat-lined, the State Department managed to receive a slight increase over last year’s funding levels.  I can’t help but think that having a politically powerful Secretary of State had something to do with this. Recall this passage from Ryan Lizza’s reporting in the New Yorker last month.

One Cabinet official made it clear that she did not share the President’s growing commitment to coupon-clipping: Secretary of State Hillary Clinton. She rejected the White House’s budget for her department, and wrote the President a six-page letter detailing her complaints. Some in the White House saw the long letter as a weapon, something that could be leaked if Clinton didn’t get her way. “At the proposed funding levels,” Clinton wrote, “we will not have the capacity to deliver either the full level of civilian staffing or the foreign assistance programs that underlie the civilian-military strategy you outlined for Afghanistan; nor the transition from U.S. Military to civilian programming in Iraq; nor the expanded assistance that is central to our Pakistan strategy.” She went on, “I want to emphasize that I fully understand the economic realities within which this budget is being constructed, and I share your commitment to fiscal responsibility. But I am deeply concerned about these funding levels.”

The letter contained indications of a real relationship between the former rivals. “You and I often speak about the need to restore the capacity of civilian agencies,” Clinton noted. But the general tone was stern and businesslike. It ended with an urgent plea for Obama to intervene on her behalf. “There is little room for progress unless you provide guidance that you are open to an increase in overall funding levels,” she wrote. Obama did indeed fight for some additional money for Clinton

Secretary Clinton  indicated that even if Obama wins re-election she won’t return for a second term. It will be interesting to see if these kinds of increases can be sustained when Hillary Clinton is replaced by a less politically powerful Secretary of State. I hope so, but am doubtful.