Saturday, April 25, 2009


UPDATE: below

As I've shown, the war on terror isn't the prime driver of increased government spending--it's entitlements. In Friday's Washington Post, Charles Krauthammer agrees, and questions whether Obama can fix it:
What is obviously required is entitlement reform, meaning Social Security and Medicare/Medicaid. That's where the real money is -- trillions saved that could not only fund hugely expensive health and education programs but also restore budgetary balance.

Except that Obama has offered no real entitlement reform. His universal health-care proposal would increase costs by perhaps $1 trillion. Medicare/Medicaid reform is supposed to decrease costs.

Obama's own budget projections show staggering budget deficits going out to 2019. If he knows his social agenda is going to drown us in debt, what's he up to?

He has an idea. But he dare not speak of it yet. He has only hinted. When asked in his March 24 news conference about the huge debt he's incurring, Obama spoke vaguely of "additional adjustments" that will be unfolding in future budgets.

Rarely have two more anodyne words carried such import. "Additional adjustments" equals major cuts in Social Security and Medicare/Medicaid.

Social Security is relatively easy. A bipartisan commission (like the 1983 Alan Greenspan commission) recommends some combination of means testing for richer people, increasing the retirement age and a technical change in the inflation measure (indexing benefits to prices instead of wages). The proposal is brought to Congress for a no-amendment up-or-down vote. Done.

The hard part is Medicare and Medicaid. In an aging population, how do you keep them from blowing up the budget? There is only one answer: rationing.

Why do you think the stimulus package pours $1.1 billion into medical "comparative effectiveness research"? It is the perfect setup for rationing. Once you establish what is "best practice" for expensive operations, medical tests and aggressive therapies, you've laid the premise for funding some and denying others.

It is estimated that a third to a half of one's lifetime health costs are consumed in the last six months of life. Accordingly, Britain's National Health Service can deny treatments it deems not cost-effective -- and if you're old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements.

Rationing is not quite as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing. A nationalized health insurance system would ration everything from MRIs to intensive care by myriad similar criteria.

The more acute thinkers on the left can see rationing coming, provoking Slate blogger Mickey Kaus to warn of the political danger. "Isn't it an epic mistake to try to sell Democratic health care reform on this basis? Possible sales pitch: 'Our plan will deny you unnecessary treatments!' . . . Is that really why the middle class will sign on to a revolutionary multitrillion-dollar shift in spending -- so the government can decide their life or health 'is not worth the price'?"
Read the whole thing. And see Ronald Brownstein writing in the National Journal:
Obama wants to expand government's reach to confront a wide range of challenges, such as health care, for which he is devising a universal coverage plan with congressional Democrats. In the survey, though, the upper-income groups supporting Obama generally don't look first to government for solutions. Overall, those polled split evenly -- 40 percent to 40 percent -- when asked whether ideas to improve their financial situation are more likely to come from business or government. But senior managers, the self-employed, knowledge workers, and the affluent all tilt sharply toward business. Likewise, those high-status groups are more inclined than the country overall to view personal action, rather than government programs or business initiatives, as the best way to achieve greater security in paying for retirement, maintaining a stable income, and accumulating assets.

Health care, in two respects, conspicuously departs from this pattern. First, the country overall leans relatively more toward government and less toward personal action (such as lifestyle changes) as the best way to ensure affordable care. And, in contrast to their view on other issues, the high-status groups are as likely as everyone else to look primarily to government for solutions. Drew Altman, president of the nonprofit Kaiser Family Foundation, says that the number to watch in the health care debate is the percentage of people who think that reform will make their family better-off rather than worse-off. In the Heartland poll, the first group was roughly twice as large as the second. Most upscale groups divided about the same way. That's encouraging for Obama.

Still, given the priority they place on autonomy and their skepticism about Washington, these better-off Obama supporters may be especially sensitive to charges that his initiative will reduce choice by increasing government control over health care. Avoiding the Big Government label that helped sink President Clinton's universal coverage proposal may be critical not only to Obama's sustaining approval for his reform plan but also to his solidifying his unusually diverse coalition of support.

Obama is preparing to enact his healthcare policy without bi-partisan support:
Potentially removing a major obstacle to the sweeping health care legislation sought by President Barack Obama, senior Democrats on Capitol Hill have reached broad agreement on a plan to prevent Republicans from blocking such legislation later this year, according to congressional officials.

The plan, which would use special provisions of the budget process to prevent a GOP filibuster in the Senate, threatens to sow outrage among GOP lawmakers and could complicate Democrats' efforts to push through the rest of their agenda.

But the president and his allies on Capitol Hill believe their decision to use the so-called budget reconciliation process will allow passage of the kind of health system overhaul that has eluded Washington policymakers for generations. . .

Adding health care to the list of measures that will be treated as part of the budget resolution process would allow Democrats to pass health care legislation with 51 votes in the Senate instead of the 60-vote supermajority normally required to avoid a filibuster.

With at least 58 Democrats in the Senate, that would all but guarantee that Democrats would not need a single GOP vote in the House or the Senate.
(via The Corner, Doug Ross)

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