Tobacco Documents Online

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0 FOCUSING ON PREVENTION AND THE NEXT GENERATION HIGHLIGHTS Through .careful investment in prevention, the Nation can aver~ premature deaths, extend • women, infants, and children (WIC) nutri- tional assistance (+go/O); Head Start (+27%); average life expectancy, and reduce illness and disability. To maximize the effectiveness • access to primary care services/community and migrant health centers (+21%); of the resources, devoted ~ prevention, the budget fo~uses on those activities which will yield the greatest results in terms of improved health outcomes. The budget proposes to increase investment in programs serving chil- drdn to $100 billion, .up from $60 billion in 1989. The budget accelerates and. expands the investments in prevention and children high- lighted in the 1992 budget, including increased funding .for. • childhood immunizations (+18%); • infant mortality/1-1ealthy Start (+17%); • Ndfional Health Service Corps (+9o/0);. • nutrition education (+17%); • " breast and cervical ~ancer (+24%); • tot~l.:I~./AiDS funding (+-13%); •smoking cessation (+5%); • injury" preventioh (+9%); • :family planning (+8%); '" : ~berculosm pre~;en on Table 5-1. THE BUDGET PROVIDES SUBSTANTIAL INCREASES FOR PROGRAMS FOCUSED ON PREVENTION AND THE NEXT GENERATION Initiative (Obligations in millions of dollars) 1989 1992 1993 AcCrual Enacted Proposed Percent Percent 1992 to 1993 " 1993 CDC Childhood Immunization ............................... Infant Mortality Reduction ..................................... (Healthy Start) ..................................................... Women, Infants, and Children Nutrition Assist- ante (WZC) ............................................................ Head Star~ ................................................................ Access to Prknary Health Care Services ............... (Community/M/grant Health Centers) ............... (National Health Service Corps) ......................... Nutrition Education ............................................... Breast and Cervical Cancer Mortality Prevention Smoking Cessation .................................................. Physical Fitness and Diet ...................................... Injury Prevention ..................................................... Family Plann/ng ................................................... CDC Lead Poisoning Prevention ............................ Tuberculosis Control ............................................... 141 297 349 5,681 7,950 9,.q65 -- 64 143 1,929 2,6O0 2,840 1,235 2,202 2,802 4,184 6,334 7,643 ~82 594 684 48 I00 120 138 152 178 -- 416 515 78 106 111 68 100 102 1,482 " 1,862 2,026 333 461 498 -- 21 40 21 32 66 +18% +148% +18% +65% • +128% N/A +9% +27% +21% +15% +19% +17% +24% +5% +2% +9% +8% +90% +106% +47% +127% +83% +42% +150% +2.3% N/A +42% +50% +37% +50% N/A +214% Part One-69 T14662-3282

FOCUSING ON PREVENTION AND THE NEXT GENERATION Part O~e--75 Table 5-8. THE BUDGET INCREASES SUPPORT FOR PRIMARY CARE SERVICES BY 21 PERCENT (Objections in raisons of dollars) 1989 ,,, I~32 1993 1990 1~91 ~t~d ~ Matermd end Ch~ Health Block Grant ................................................ 564 5~4 687 Health Care for the Homeless .............. National Health Service Corps .... ._ .....48 61 91 HCFA--Medicaid and Medicare .......... 3,085 3,493 4,292 Total Federal Spend~g ..................... 4,184 4,640 5,561 Dollar Percent Per~nt 530 594 684 4-90 +15% +42% 650 674 +24 +4% +22% 56 68 +12 +21% 4-363% 150 1£0 +19 +lg% +150% 4,934 6,097 +1,168 +24% +98% 6,334 7,643 +1,308 +21% +8b~6 rate of about 4 percent, due largely to the increased use of pap smears. While breast cancer remains a leading cause of death, the use of mammography for early detec- tion is the best current hope for prevent- Lng breast cancer deaths.1~- The budget will invest an additional $99 million for screening through the Medicare program and through the Public Health Service (see Table 5-9). Of these amounts, CDC will spend $70 million on breast and fold increase since 1990. This inwstment will" focus resources on screening low-in- come, high-risk women in age groups for which screening is recon~nended who oth- erwise would have no other access to these prevention activities. • HIV/A[DS Fundir~g.--Total HIV/AIDS funding increases by 13 percent to $4.9 billion. This represents an increase of 118 percent in total HIV/AIDS funding since 1989. Funding for HIV/AIDS treatment cervical cancer screening grants, a 40 per- also increases substantially (+20 percent) cent increase over 1992 levels, and a 14-over 1992. • 8rooking Cessa~on.--Accer~ng to a report __ 1~Dopartm~nt of H~slt~ and Hum~ se~, H~m C~ ~i. the Surgeon General, continued invest- . ~.c.: u.s. Govern~en: Pr~n:~ O~. ~990). merit in smoking cessation, par~iculerly if Table 5-9. THE BUDGET INCREASES SUPPORT FOR BREAST AND CERVICAL CANCER SCREENING (Obligations in millions of dollars) 1992 1989 1990 1991 Enacted 1993 1~C~2 ~: Change: Proposed 1992 to 1~ 1993 HCFA--Medicare: Mammograms .............................. Pap Smears .................................. PHS (CDC Screening Grants, IHS Screening, NIH and AHCPR Re- -- 170 290 3O 6O 6O 360 +70 +24% 70 +10 +17% Total Federal Spending ............... 45 272 416 515 +19 +29% TI4662-3283

Part One-76 ~ BUDGET FOR FISCAL YEAR 1993 Table 5~10: TOTAL AIDS ~'NDING INCREASES 13 PERCENT OVER 1992.42[[} 11~ PIgmENT OVER 1989 (Obligations in millions of dollars) Dollar Percent Percent 1989 1992 1993 Change: Change: .-- 1993 1993 1993 HIV/AIDS: Research ........................................... 892 1,189 1,238 +49 +4% +39% Treatment ......................................... 7~7 2,096 2,507 - +411 +20% +240% Prevention ........................................ 483 594 621 +27 +5% +29% Income Support .......... ~ ................... 153 492 570 +78 +16% +273% Total Federal ..: ............................. 2,265 4,371 " 4,936 +565 +13% +118% Note: The figures above m-e p.reliminary.estima .t~. for programs-in h~e .Departments of Health ,~a~.d Human Services, Defense, Vetera~ Affair~,- Educatmn, Justice, State, Labor, and independent agencies. The total also includes estimated obligations for the Social Security Admin~tration. In addifio.n to the spending identified above, the budget includes other initiatives, most notably those related to drugs and infant mortality, that r~ntribute to the fight against HIV and AIDS. targeted towards pregnant women, is like- ly to yield beneficial returns. Smoking dur- ing pregnancy retards fetal grow~, re- duces birthweight, and doubles the risk of having a Iow-birthweight baby.ts Studies have shown a 25-50 percent higher rate of fetal and infant deaths among women who smoke during pregnancy compared with those who ~to not.14 One study even suggests that each dollar invested in smoking cessation for pregnant women may yield about $6 in averted costs for neonatal intensive care and extended care for low-birthweight infants,t5 Beyond the damage tobacco use during pregnancy may cause, smoking is also a factor in the deaths of over 400,000 Americans every single year.16 The budget increases suppor~ of smoking cessation by 5 percent over 1992 levels (see Table 5-10). Included in this increase is an additional $3 million for the CDC Office on Smoking and Health, en,abling CDC to expand its smoking cessation edu- cation activities for specific at-ris~ lations, including minority an~ come, pregnant women. Lead Poisoning Prevention. Lead poisoning is the most common environmental disease of young children, disproportionately af- fecting poor, minority children in the inner cities. Yet childhood lead poisoning may be preventable. Preventing lead poisoning is a two-step process: first, lead poisoning must be de- tected, and second, the source of the poi- soning should be abated. The budget in- dudes $40 million, a 90 percent increase, for CDC Lead Poisoning Prevention Grants which suppor~ about 30 state-wide lead poisoning scredning programs. CDC grants allow states to identify low-income children at risk of lead poisoning and refer those with high blood lead levels for medi- cal treatment. ~ In addition to the CDC grant program, the Department of Housing and Urban Devel- opment (HUD) will continue assisting low- and moderate-income private residential proper~y owners abate lead-based paint by providing $24 million in grants to States and localities. HUD's public housing mod- ernization program will continue to be the main source of funding for lead-based paint testing and abatement activity in TI4662-3284

(Obligations in millions of dollars) Actual 1989 1990 1991 1992 Ena~ed Dollar Percent 1993 NIH ~nd AD~ Evaluation of Smoking Cessation Interventions and Health Effects ......................... 74 CDC (Office on Smoking Health) ............................................ 4 Tots/Federal Spending ................. 78 public housing. It is estimated that ap- proximately $50 million will be spent on these activities in 1993. • Injury Prevention. Preventing injury fl~rough encouraging increased personal responsibtllty can also save lives. For ex- ample, every 6ne percent increase in seat belt use saves more than 160 lives per year. If the U.S. were ~o increase the na- tional average of seat belt use from the 1990 rate of 48 percent to the Administra- tion's goal of 70 percent by the end of 1992, 3,800 lives could be saved annually and 100,000 injuries could be prevented-- yielding potential economic benefits of $2.5 billion.~7 The budget increases funding for injury prevention to almost $2 billion, a 9 percent increase over 1~92. These funds will be used primarily within the Depart~nent of Trausportation (DOT) for aviation, rail, highway, marine, and pipeline and haz- ardous material transportation safety. An estimated 50,000 lives are lost annually in incidents in the transportation sector. DOT will use these funds for safety inspec- tion and enforcement, research and devel- opment, and education programs all aimed at reducing accidents in the transportation sector. The budget also includes increased emphasis on reducing drunk driving and increasing occupant protection. Highway Traff~ Safety Admln~tration staff e~ti- 76 87 96 98 +2 +2% 5 6" 10 81 93 106 13 +3 +3~ 111 +5 +5% • Fc~m~ly Planning. Studies suggest that in- vestments in family planning may also yield high re~urn.s. Some studies attribute reductions in infant mortaHLT achieved over the last 20 years in par~ to effective family planning,is Recognizing the impor- f~mce of these services, the budget con- t~ns an additional "$37 million for HI-IS family planning grants and Federal Medic- aid payments, an increase of 8 percent (see Table 5-12). * Physical Fitness and Diet. Additional in- vestment in efforts to improve physical fit- ness and diet may yield significant re- turns. Studies show that regular physical a~ivity can help prevent or manage core- nary heart disease, hypertension, non-in- sulin dependent diabetes, osteoporosis, and obesity. People who are active have lower rates of colon cancer and stroke, as well as fewer back injuries. Moreover, changes in diet have been shown to reduce the risk of cardiovascular disease and st~ke. The budget increases funding for health education, disease prevention, and phys- ical fitness activities. The budget also fo- cuses on bringing health promotion and disease prevention activities to older Americans. The Administration on Aging will provide more health risk assessments, ~sInstitute or"/,~tidne C, ommi~ee to Stud~ the Preveation o~ Low Birth~veight, --0~,~ Lo~ 8/~thwd~t (V;~hlngton, D.C.:" TI4662-3285

FOCUSING ON ~ON AND TH~ NEXT GKNERATION Part better to pay $65 to ~mrmmi~.e a child fully for measles, mumps, and rubella than pay the roughly $7,000 it costs to hospitalize a child for a c~e of measles.~7 Third, investments in prevention which focus on vhildren c~ ~lp p~a~ t~ Nation% ch~ for a ~Ithy a~ p~ tire ~tum. M~y of the most ~po~t risk farm for c~c ~e~v ~ ad~ have the~ ~ ~ beha~o~ a~d d~g c~ood.~ ~ genera~on h~ a i~ ~ e~ ~at ~n get a good s~ ~ life, ~d that ~e Na~o~'s chil~en cont~ue ~ ~pmve on the c~nt 75-ye~ life sp~. ~ ~e ne~ generation of ~eEc~ ~ows up, it sho~d enjoy ~e benefi~ of effo~ ~ prevent m~y of the ~eases ~d deaths that ~i~ ~ generation. While many activities may be included. under the broad heading of "prevention,"~ not all prevention activities lead directly to a reduction in disease or in lives saved. A useful framework for distinguishing among prevention activities is to separate them by type: "S¢ll~-lib.e So/=ffons"---In 1958, Dr. Jonas Salk developed the polio vaccine and since that time polio has nearly been eradicated from the Western Hemisphere. Interventions like Dr. Salk's polio vaccine are the ultimate preven- tive measure; they directly prevent a specific disease from occurring. Further, such "Salk- like Solutions" are generally the most effective since success does not depend upon follow-up actions. Through intensive medical research, the Nation is trying to find more "Salk-like Solutions". Diagnostic Interventions--Such preven- tion activities include blood lead level screen- ing, pap smears, mammograms, and blood cho- lesterol screening. Diagnostic interventions are generally intended to detect a condition or to assess the likelihood that a condition could ~Baeed upon Centers for Disease Control esthnates of the co~t to immunize one child for the full schedule of me~|es, mumps, rubella vaccine as recommended by the Advisory Committee on Im- mtmizatlon Practices, ~nd on CD~ estimates of the c~st of hos. pitalization for mea~le~. The estimates assume that each vaccine i~ purchased at the projected 1993 Federal contract price. exist before it becomes a serious health risl~ For example, mammograms do not prevent breast cancer, but with early detection and proper medical follow-up, can reduce or pre- vent breast cancer mortality. Interventions to Modify Behavior--Such prevention activities include educational cam- paigns to reduce smoking or increase the use of seat belts, or the purchase and delivery of nutritional food to low-income pregnant women and infants. Diagnostic interventions and interventions designed to modify behavior are not necessarily mutually exclusive. Certain prevention activities may be diagnostic inter- ventions which require medical follow-up and may also be designed to modify behavior (for example, testing for HIV or sexually transmit- ted diseases; or giving nutrition assistance and counseling to a pregnant woman). Identifying effective preventive measures, so prevention can be promoted and encour- aged, is a most important step in achieving a healthier society. Unforbunately, there are few "Salk-like Solutions," so most prevention activities depend upon personal responsibility, focusing on fm~er medical follow-up or changes in personal behavior to be effective. PREVENTION AND THE IMPORTANCE OF PERSONAL BEHAVIOR Preventing Deaths and Illnesses: Better control of fewer than 10 factors--such as diet, prenatal care, exercise, the use of tobacco, alcohol and illegal drugs, and the use of seat belts--could prevent between 40 and 70 percent of all premature deaths, a third of all cases of acute disability, and two- thirds of all cases of chronic disability (see examples in Behavior Change chart). Many of these factors involve freely-made individual choices. Since the preservation of individual choice is a cornerstone of American democracy, disease and injury prevention must become personal as well as national priorities. The Past." Favorable health effects of past changes in behavior have been significant, as investments in prevention and associated policies designed to promote healthy behavior have yielded results. ~SDepartment of Health and Human Services, Testimm*y of Dr. J. Michael McGinni~. Deputy .e~istant Secretary for Health, Department of Health and Human Services, before the Senate Gov- ~ • 8rgtokirtg. The Nation has witnessed the eramentat Affalr~ Committ~e.N~ember 14, 1~91.f effects of changes in behavior across soci- 3L%-000 0 - 92 - 6 T14662-3286

Par~ One-S2 THE BUDGE~ FOR FISCAL YEAR 1993 CHANGE IN BEHAVIOR, FARLY DETECHON AND INTERVENTION COULD P~: CARDIOVASCIKAR DISEASE 45% OF DEATHS 50~OF DISABHA2Y O 10 20 30 40 ESIIMATED % OF DEATHS OR DISABILITY P~ ety as the incidence of one of the leading contributers te preventable deaths, smok- ing, has declined from 40 percent in adults in 1965, te 28 percent in 1990. This dra- matic behavior change was brought about through a complex combination of actions by individuals, private industry, health providers, and all levels of goverr~nent~ (see chart). • Traffic Accidents. Increased use of safety belts, declines in drunk driving, and better vehicle crashworthiness have cut the traf- fic fatality rate by 50 percent since 1973. If the traffic fatality rate had remained at the 1973 level, an additional 40,000 lives would have been lost in 1991 alone. One of the most important factors in re- ducing the traffic fatality rate has been the growing use of seat belts and child ~afety seats. As shown in the accompany- ing chart, simply accepting the personal responsibility for using these safety de- vices has saved numerous lives. As people increase their use of seat belts, child safe- ty seats, and air bags, the Nation will see more lives saved every year. Air bags will be installed in an estimated 90 percent of all new cars sold in the United States by 1995. * Heart Disease and Stroke. During the 1980s, death rates declined for two of the leading causes of death among Americans: heart disease and stroke. Much of this progress is attributable te changes in be- havior. The more than 40 percent decline in heart disease mortality since 1970 re- flects dramatic increases in high blood pressure detection and control, the decline in cigarette smoking, and increasing awareness of the role of blood cholesterol and dietary fat. Stroke death rates, which have dropped by more than 50 percent in the same period, also reflect gains in hy- pertension control and reductions in smok- ing. The Future: Building on the successes of these previous prevention investments, the 1992 President's Budget focused resoruces TI4662-3287

5. FOCU~I~G ON PREVENTION AND THE ~ GENERATION Par~ One-83 pERCENTAGE OF ADULT /~tERICANS WHO SMOKE CONTINUES TO DECLINE 35 3O 25. 196~ 1970 1975 on p~ven~on. ~s budget ~ ~d ~d deepen ~e nations co~i~ent ~ c~ ~ves~ent ~ p~ven~on. ~ ~1 be m~y benefici~ ~s~ ~m 1993, ~clu~g: • 6,710,000 pol~ immuni~t~, 4,~47,000 me~s, mumps, and ~bel~ immun~- t~, ~ ~,600,000 ~patit~ b immuni~- • an ~it~l 157,206 chi~ren per year will be enml~d in He~ Start (all e~ected year of H~ • 445,000 more perso~ will ~ve ~eess to p~ma~ ~ serves thm~h ~mmunity ~tth centers; • at ~t 96,000 mo~ women per year will ~ sc~e~d for b~t a~ ce~l • 19L000 mo~ ~ a~ ~s~ per year will eit~ quit or 1980 198~ • 125,000 more children per year will be screened for lead poisoning. The combination of additional dollars con- tained in the budget and continued improve- ments in healthy behavior should help main- rain the declining trends in morbidity and mortality~providing better lives for all Ameri- cans. The importance of personal responsibil= ity: Each individual citizen is the final and perhaps most crucial player in improving the health of the Nation. Measurable improve- ments in health outcomes can result from changes in individual health behaviors. The normal course of daily activity presents each person with numerous opportunities for pro- rooting health and preventing disease. Yet with each opportunity comes the responsib'dity that each person has for his or her own personal health habits.~9 ~U~. I~p~ment of Health and Hama~ S~r~dces, Pabl~c HeaRh Sert,~, H-e~d~hy People ~000: Nat~ He~d~t z~'onu~on TI4662-3288

1-31-92 (DER) FEDERAL BUDGET (No. 21) B - 15 of Market Regulation will " New York Stock Exchange 20 largest 1933ActFees In other matters, McConnell said the SEC will not seek an increase in 1933 Securities Act registration fees under Section 6(b) of the Act. Currently, those fees are 1/32th of 1 percent of the aggregate offering amount. The fees are deposited in a special account and are used solely to recover the cost of processing securities registration. The SEC collected in fiscal 1992 an esti- mated $230 million in Section 6Co) fees and is projected to collect an estimated $256 million in such fees in fiscal 1993, according to the budget~e.stimate.[:] NRC BUSH'S REQUEST FOR NRC $550 MILLION FOR FY 1993 President Bush's fiscal 1993 budget request, trans- mitted to Congress Jan. 29, requests $550 million for the Nuclear Regulatory Commission, which oversees non-military nuclear operations and materials in the United States. The request is $37.5 million more than was appro- priated for 1992. NRC is requesting $163.3 million for its reactor safety and safeguards regulation program, an in- crease of $8.6 million from fiscal 1992, it said. For its nuclear safety research program, it is requesting $121.4 million, an increase of $7.5 million from the amount appropriated for fiscal 1992. NRC's request also included $40.8 million for fiscal 1993 for its nuclear material and low-level waste safety and safeguards regulation program, the agency said. This represents an increase of $1.5 million from the amount appropriated for fiscal 1992. For its high-level radioactive waste regulation pro- gram, NRC is requesting $21.1 million for fiscal 1993, an increase of $2.3 million from fiscal 1992. NRC is requesting $33.8 million for its special and independ- ent reviews, investigations, and enforcement program, $1 million more than was appropriated for 1992. The agency is requesting $165.0 million for its nu- clear safety management and support program for fiscal 1993, $15.7 million more than it received for fiscal I992. Finally, NRC is requesting $4.6 million for the Office of the Inspector General, an increase of $.9 million from 1992.,~ years have worked to revitalize the FDA, with re- forms in the drug approval process and with improved labeling regulations for virtually all foods. The FDA request is part of the HHS 1993 budget request, which is $585.2 billion. The FDA is responsible for regulating foods, drugs, cosmetics, and medical devices -- which account for approximately 25 cents out of each dollar of consumer spending. The agency has experienced significant growth in available resources since fiscal 1989, with a 47 percent increase in funding and a 21 percent increase in staff, according to the department's budget request. Specifically, the FDA portion of the FY 1993 HHS budget request includes $344 for regulation of drugs, $213 billion for foods, $122 million for medical de- vices, $34 million for the National Center for Toxico- logical Research, $70 million for program management, $8 million for buildings and facilities, and for a revolving fund of $6 million. The budget request assumes the availability of ap- proximately $200 million from user fees to manufac- turers that submit applications to market new products, annual fees for existing facilities and prod- ucts, and fees for imported food products. Congress has never approved user fees for FDA. Research, Disease Prevention ~ In his remarks, Sullivan emphasized ~he depart- ment's commitment to the importance of research and development and programs that spotlight disease prevention. "We have brought disease prevention and health promotion to the forefront of health policy," Sullivan said, outlining HHS funding for prevention activities of $8.7 billion for FY 1993, an increase of 56 percent since fiscal 1989. Included in this amount are a 40 percent funding increase over 1992 levels for prevention of breast and cervical cancer; an 88 percent increase for childhood lead poisoning prevention; a 100 percent increase to control the outbreak of tuberculosis, and an 18 percent increase for immunization funding. The budget request also includes increased funding for biomedical and behavioral research. The request for the National Institutes of Health is $9.4 billion, an increase of $443 million over 1992 levels. The request will sup- port 22,132 research project grants and will also support for several science initiatives such as activities related to biotectmology, science education, high-performance computing, and advanced materials research.El FDA BUSH PROPOSES 4 PERCENT INCREASE; REQUESTINCLUDES USER FEES PROPOSALS The Bush administration's budget request for fiscal year 1993 includes $797 million for the Food and Drug Administration, a 4 percent increase of $32 million for FDA over the fiscal 1992 level, Health and Human Services officials announced Jan. 29. In announcing the details, IIIIS Secretary Louis Sullivan said programs undertaken in the last three OMB BUDGET AGENCY, REGULATORY REVIEW OFFICE RECEIVE MINOR INCREASES IN '93 BUSH BUDGET President Bush's fiscal 1993 budget includes a pro- posed increase of $2.54 million in bridget authority for the Office of Management and Budget, including a slight increase of $172,000 for the Office of Informa- tion and Regulatory Affairs, which reviews all pro- posed federal regulations. Copyright O 1992 by THE BUREAU OF NATION/d_ AFFAIRS, INC., Washkcjton, D.C. 20037 TI4662-3289

Page 6 Congressional Monitor Appropriations Claim Smaller Piece of Budget Pie The changing composition of the federal budget makes it more difficult for President Bush and Congress to combat the nation's economic ills through in- creased spending on domestic programs. Because an increasing portion of the federal budget automatically goes toward entitlement programs -- such as Medicare -- and interest on the federal debt, Con- gress has much less control over the federal budget than at any other time in history. Funding levels for entitlements, known as mandatory spending, are deter- mined by how much is needed to cover all eligible participants. Most mandatory spending is not subject to appropriations and is much more difficult to change. Lawmakers have the most direct influ- ence over discretionary programs, which are subject to annual appropriations. But, out of a total budget of $1.517 trillion requested by Bush for fiscal 1993, only about one-third -- $537.0 billion is slated for discretionary spending. Over the past 30 years, the amount of spending that Congress directly controls has plummeted, from 70 percent of the total federal budget in fiscal 1962 to just 37 percent of the total in fiscal 1992. (See adjacent chart for fiscal 1993 ratios) In contrast, mandatory spending ac- counts for nearly 50 percent of the fiscal 1992 budget, while it made up just 28 percent of the budget 30 years ago. Congress' diminished control over the budget irks appropriators, who have seen their power ebb. William H. Natchar, D-Ky., who has been on the House Appropriations Committee for 37 years, says that he has watched as Cqn- gress lost authority over federal spend- ing, "all because we can't seem to say no to entitlement programs." But while many members say that rising entitlement costs are the biggest budget problem facing the United States, programs such as Social Security, Medi- care and farm-income supports are sa- cred cows that lawmakers cut at their own political risk. "Any suggestion of en- titlement cuts is not taken well" back home, says Natcher. An agreement was reached in 1990 to reduce projected spending for Medicare and other entitlement programs by $99 billion through fiscal 1995, but only as part of a broader budget deal agreed to by Bush and lawmakers. Bush has proposed additional enti- tlement cuts, along with a long-term cap on mandatory spending, but Democrats are expected to balk. Lloyd Bentsen, D- Texas, chairman of the Senate Finance Committee, said that further cuts in most entitlement programs could not be made without imposing real hardship. • Budget in Perspective (fiscal 1993, outlays in billlon~ of dollars) International 1.36% Other 12.75% Federal Retirement 5.35% Deposit Insurance 4.99°/'0 Medicare 7.65% SOURCE= FP~a11993 Budget [] Discretionary [] Mandatory 16% - 15" 14" 13. 12" 11 10 9' 8' '81 °82 '83 '84 '85 Net Interest (percent of total budget by fiscal year) _l I_LJI_L ,, 1 ._t_.L =_L_ ,--" . ; t ! --J I i i j l : i i 32% 28 26' 24 22 20 18' 16 Social Security (percent o f total budget by fmcal year) ' ' tt , I , I I ! 1~, 1 I!l!,,,,,I ! ~ II ~iI I I 1 • I i i I,Ii -~ _ .-_#f% i 1 Vl ' : t i I -T--V-I~T---r.-- I ! ! ! t! ~ ! t i ! ! ! ! i t i i '81 '82 '83 '84 '85 =86 '87 '88 '8,9'~0 '91 ~92 Economic Assumptions Bush Administration 1992 1993 Congressional Budget Office 1992 1993 Inflation-adjusted GDP Growth 2.2% 3.0% 2.8% 3.3% Consumer Price Index # 3.1% 3.3% 3.4% 3.6% Unemployment * 6.9% 6.5% 6.9% 6.4% 91-day Treasury Bills 4.1% 4.9% 4.4% 5.1% 10-year Treasury Notes 7.0% 6.9% 7.1% 7.1% TI4662-3290