Back in 2007, one of the final years of the Earmark Era, the following institutions received funding in the Labor, Health and Human Services and Education Appropriations bill to meet an array of critical health-related needs:
- Alleghany Memorial Hospital in North Carolina for an electronic medical record system;
- Beaufort Memorial Hospital in South Carolina for its Cancer Center; and
- Atchison Hospital in Kansas for medical equipment.
When earmarks went away, many institutions re-oriented themselves toward “competitive” grants – which had always represented the bulk of federal funds invested locally, but were allocated based on stringent application processes. Applying for these grants is currently the only way for hospitals across the country to attempt to access federal funds for these needs. Let’s take a look at some of the institutions that dominated the list of recipients of HHS/NIH funding last year:
- Cedar-Sinai Medical Center in Los Angeles;
- The Cleveland Clinic in Ohio; and
- Johns Hopkins Hospital in Baltimore.
See a trend developing here?
There are a number of reasons that earmarks make sense. Beyond the well-worn argument that Members of Congress are simply fulfilling their constitutional duty to control the nation’s purse-strings, earmarks serve as a powerful tool to get tough legislation passed, especially bills that keep the government funded.
There is also a compelling case to be made that earmarks act as a great equalizer for institutions that do not conduct Tier 1 research, and are not located in urban areas on either coast, but still provide high-quality health care to communities that are often under-served.
Throw in the fact that earmarks do not increase overall federal spending and that Members of Congress know a lot more about their Districts/States than bureaucrats in Washington, DC, and the current effort on Capitol Hill to take another, tentative look at reviving earmarks seems more than justified.
That’s not to say that Congress shouldn’t guard against abuses. Before earmarks were essentially banned in 2010, Congress had already taken concrete steps to enhance disclosure and transparency in the process. Members had to publicly list the earmarks they were requesting and had to agree to have their names attached to the funding in the respective appropriations bills. There are certainly further steps that Congress could take on the transparency and accountability fronts to ensure we don’t return to some of the excesses that previously gave the practice a black-eye.
But overall it is important to remember that more often than not earmarks existed at the intersection of the public need and the public good, and allowed Members of Congress to demonstrate in measureable ways that they were hard at work for their constituents and getting the nation’s business done. I would think that we would all welcome a return to that sentiment.
What do you think? Would bringing back earmarks be a good thing? Let us know your thoughts at email@example.com