Macro-Budgets, Micro-Budgets, and Politics of the Possible

To refresh readers: the macro-budget is the entirety of Federal spending (about $4 trillion), of which just over $1 trillion is spent on discretionary programs (defense, social programs, FDA, etc.). In contrast, the micro-budget is all about FDA, its priorities, accomplishments, needs. Because of the limited ability of any interest group to impact macro-budgetary issues, the Alliance’s focus is on FDA and its budget.Given this difference in focus, a week like this -- plenty of big-picture budget news, not much to tell about FDA appropriations -- provides a great opportunity to answer the question: why does the Alliance devote so much coverage to macro-budgetary policy and politics in its weekly communications?Foremost, the macro-budgetary struggles that grab headlines also dramatically affect how much (or how little) is available to spend. Even divvied in thousands of pieces -- as our nation’s trillion dollar discretionary budget is -- it is the top-line macro numbers that drive the floor and ceiling for how much FDA might receive in a given year. For example, if Congress were to accept President Obama’s overall spending totals, which presume higher caps on discretionary spending, then FDA’s prospects would be significantly better than under either the House or Senate budget resolutions that adhere to the current-law budget caps.Over time, macro-budgetary issues have an even more profound effect on FDA. Much of Congress understands or could be persuaded that FDA funding should be a national priority. (One of the Alliance’s key goals is to expand the number of such Members and to keep reinforcing FDA’s cause.) Should macro-budget issues be resolved in a way that allows even a little more domestic discretionary spending, we believe that FDA could readily justify being a beneficiary of some of the expanded funds. FDA would have a bipartisan group of Members that would press for it. Thus, FDA’s long-term, as well as annual, prospects are suppressed by Member’s belief that monies available for new funding will be limited by macro-budgetary constraints and even priority agencies will see little or no growth.Finally, the macro-budgetary process is one of the key arenas for discussing large national priorities. For example, this week’s Senate HELP hearing on medical innovation -- occurring as it did while the Senate was about to consider the budget resolution -- became a platform for both Members and witnesses to speak in terms of FDA and NIH as critical priorities for improving the health and well-being of Americans.We never lose sight of Congress’ micro-budgetary judgment of FDA. It drives the agency’s appropriation in most years. But we all recognize that Congress’ good opinion of FDA and its mission (something we work hard for) is necessary but not sufficient to ensure an increased budget for the agency. The larger context also matters.Note: This week’s Analysis and Commentary was written by Steven Grossman, the deputy executive director of the Alliance for a Stronger FDA.