Harold Pollack is a public health policy researcher at the University of Chicago's School of Social Service Administration, where he is faculty chair of the Center for Health Administration Studies. He is a regular contributor to The Treatment.

Over at HuffPo, reporter Ryan Grim reveals that the Obama administration is holding off on its pledge to revoke the ban on federal funding for needle exchange. As Grim reports in this fine little story: 

… Obama's budget includes language that bans spending federal money on needle-exchange programs. White House spokesman Ben LaBolt said the administration isn't yet ready to lift the ban - but Obama still supports needle exchange.
"We have not removed the ban in our budget proposal because we want to work with Congress and the American public to build support for this change," he said. "We are committed to doing this as part of a National HIV/AIDS strategy and are confident that we can build support for these scientifically-based programs."
He added, "In recent years, Washington has used the budget process to litigate divisive issues and score political points. This practice, which both sides have engaged in, has limited our ability to tackle our major economic challenges. President Obama decided not to play politics as usual with this budget and while he remains committed to supporting the program he wants to address that through the normal legislative process."

Grim also reveals cheesy modifications to the White House website that downplay the needle exchange issue. As a public health activist who often works in this area, I share the disappointment of many colleagues. This isn’t the moment to argue the policy merits. I’ll just say that the needle exchange issue is important in its own right, and as a sharp break from the crude politics of the drug war to more humane, evidence-based efforts. A trainload of academic studies and Institute of Medicine reports bolster these points.

Our disappointment is not allayed by the President’s proposed 2010 budget, which requests only $53 million in additional HIV prevention monies.

These issues hit especially close to home. I was one of the core group of Obama supporters who helped to rally the public health community during the primary season and after. I hit the needle exchange and budget issues hard on many occasions. My first hectoring memo to campaign staff is dated June 13, 2007. More followed.

I would be furious if it weren’t for all the other items on the President’s docket: Health reform, the banking and auto bailouts, one or two military and diplomatic matters offshore. Getting bogged down in the messy culture-war politics of needle exchange can’t be an appealing prospect, especially when key public health officials who might explain and defend a policy change aren’t even hired yet.

Most of us in the public health community are strong Obama supporters. Playing this role of loyal supporter can be frustrating. Much of the time, politics is about persuading the undecided, marginal voter or legislator. Since time immemorial, members of the Democratic and Republican base have watched their presidents seemingly take them for granted.

This President has earned some trust on these points. He’s facing a maelstrom of political and policy dilemmas. Loyalty requires us to give him the space and time to maneuver the signature legislative accomplishments by which his legacy will be judged. Universal coverage, for example, would be a tremendous victory for both the public health community and for Americans most directly affected by the HIV epidemic. And I trust House Democrats will happily augment the HIV prevention budget items.

In delaying the promised repeal of the needle exchange ban, President Obama has written a big IOU, which I will deposit in the drawer. Embracing the Obama cause was one of the best decisions I ever made. Still, every now and then I will be checking on that IOU. Sometime soon, the President needs to honor it.

--Harold Pollack