In September 2008, then-Candidate Obama, in his first
Presidential debate with Senator John McCain, pounced on his rival when McCain raised the hard-hearted suggestion of freezing all government spending with the
exception of defense, entitlement programs, and veteran’s affairs, to reduce the deficit.

Obama countered with a now-famous and punchy one liner:  “The problem is you’re using a hatchet
when you need a scalpel.”

This week, the President seems to have taken up the hatchet
and embraced the McCain approach. It’s not quite his “read my lips” moment, but it has – at best – the
potential for the most fundamental of disappointments.

The issue is that the President’s retort was not just a
really well constructed and pithy punch to McCain’s cold-as-steel demeanor – an
appeal from the compassionate candidate who knew and understood the challenges
of the everyday American. No, it
was, first and foremost, a profoundly moral statement. It was meant to underscore that the
President viewed domestic needs as not just important, but a fulfillment of the
social contract we have with one another as Americans and he saw a federal
government shirking its responsibilities at home.

It was the modern equivalent of President Lincoln’s line
that the role of government is “to do for the people what needs to be done, but which they can not, by
individual effort, do at all, or do so well, for themselves."

Obama’s quip underscored that
the government was not performing its primary function in the way Lincoln
described. In fact, Obama went on
to say that "There
are some programs that are very important that are currently underfunded,"
Obama said.

The real truth is that the President has not really,
fully taken up the McCain proposition. Not fully. The President
will not propose that everything – every line in the federal budget – get
frozen in time for his proposed three-year timeframe.  Instead, there will be a mixture of things that are cut,
flat funded, or even given increases. And while such outcomes are always the product of the budget process,
the 2011 federal budget he will propose next week is unique in that wherever
programs fall along the fault lines of the top line spending freeze, it will
say volumes about the moral vision of the President and his Administration.

For those of us who work on behalf of sexual and
reproductive health who have one hand in public health and the other in social
justice, we’re nervous.  We’re
nervous because the issues we care about most have languished for the better
part of a decade as the federal government failed to meet the unmet need to
secure sexual health in our country. 
Instead, STD prevention and services funding has stalled, causing clinic
closures and impacting the ability of people to access prevention and treatment.  HIV funding has fared a bit better, yet
people with HIV or AIDS are once again on lists across the country waiting for
government support to access live-saving medications.  Family planning funding has limped along but its increases –
when they came – paled in comparison to the billion dollars spent on wasteful
programs like abstinence-only-until-marriage during the same time period. This has created the most striking lack
of adequate services from coast to coast. So no one should wonder why we have 19 million new cases of STDs every
year, or an HIV epidemic worse than we ever thought possible, or rising rates of teen and
unintended pregnancies.

This week, the President also made one of the most remarkable
statements of any President in recent memory when he said, “I’d rather be a
really good one-term president than a mediocre two-term president.” I don’t think it was the insincere
gesture of a politician struggling for purpose or seeking consolation. This is the real thing.  It is character in the truest sense of
the word and the same type of self-sacrifice that forces this good man to make
the tough decisions for a nation that, in the end, may ultimately cost him
another term – including his decision to fix the fiscally bankrupt house of
government he inherited from a previous Administration.

But that tough decision needs to recognize that our public health system in
states across the country, as well as our sense of social justice, demands that
the budget the President proposes not shirk from the moral obligation to do the
right thing on sexual health. Sure, discretionary spending is rather small in the overall picture, but
it is the critical source of funding
for sexual health programs.  We
simply cannot afford a cut from the budget scalpel anywhere on sexual and
reproductive health programs.

Anywhere.