Obama: The Grand Strategy

Unified theory of Obamaism, fifth (final?) installment:

In the service of his ultimate mission -- the leveling of social inequalities -- President Obama offers a tripartite social democratic agenda: nationalized health care, federalized education (ultimately guaranteed through college) and a cash-cow carbon tax (or its equivalent) to subsidize the other two.

Problem is, the math doesn't add up. Not even a carbon tax would pay for Obama's vastly expanded welfare state. Nor will Midwest Democrats stand for a tax that would devastate their already crumbling region.

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'?"

My own preference is for a highly competitive, privatized health insurance system with a government-subsidized transition to portability, breaking the absurd and ruinous link between health insurance and employment. But if you believe that health care is a public good to be guaranteed by the state, then a single-payer system is the next best alternative. Unfortunately, it is fiscally unsustainable without rationing.

Social Security used to be the third rail of American politics. Not anymore. Health-care rationing is taking its place -- which is why Obama, the consummate politician, knows to offer the candy (universality) today before serving the spinach (rationing) tomorrow.

Taken as a whole, Obama's social democratic agenda is breathtaking. And the rollout has thus far been brilliant. It follows Kaus's advice to "give pandering a chance" and adheres to the Democratic tradition of being the party that gives things away, while leaving the green-eyeshade stinginess to those heartless Republicans.

It will work for a while, but there is no escaping rationing. In the end, the spinach must be served.

By Charles Krauthammer – Washington Post
Friday, April 24, 2009

Posted:  Daily Thought Pad

The Sting, in Four Parts

WASHINGTON -- Franklin Roosevelt gave us the New Deal. John Kennedy gave us the New Frontier. In a major domestic policy address at Georgetown University this week, Barack Obama promised -- eight times -- a "New Foundation." For those too thick to have noticed this proclamation of a new era in American history, the White House Web site helpfully titled its speech excerpts "A New Foundation."

As it happens, Obama is not the first to try this slogan. President Carter peppered his 1979 State of the Union address with five "New Foundations" (and eight more just naked "foundations"). Like most of Carter's endeavors, this one failed, perhaps because (as I recall it being said at the time) it sounded like the introduction of a new kind of undergarment.

Undaunted, Obama offered his New Foundation speech as the complete, contextual, canonical text for the domestic revolution he aims to enact. It had everything we have come to expect from Obama:

The Whopper: The boast that he had "identified $2 trillion in deficit reductions over the next decade." It takes audacity to repeat this after it had been so widely exposed as transparently phony. Most of this $2 trillion is conjured up by refraining from spending $180 billion a year for 10 more years of surges in Iraq. Hell, why not make the "deficit reductions" $10 trillion -- the extra $8 trillion coming from refraining from repeating the $787 billion stimulus package annually through 2019.

The Puzzler: He further boasted of his frugality by saying that his budget would reduce domestic discretionary spending as share of GDP to the lowest level ever recorded. Amazing. Squeezing discretionary domestic spending at a time of hugely expanding budgets is merely the baleful residue of out-of-control entitlements and debt service, which will increase astronomically under Obama. To claim these as achievements in fiscal responsibility is testament not to Obama's frugality but to his brazenness.

The Non Sequitur: "To make sure such a crisis (as we have today) never happens again," Obama proposes his radical health care, energy and education reforms, the central pillars of his social democratic agenda. But Obama's own words contradict this assertion. Notes The Washington Post: "But as his admirable summation of recent history made clear, these pursuits have little to do with the economic crisis, and they are not the key to economic recovery." Obama rarely fails to repeat this false connection. A crisis -- and the public's resulting pliability to liberal social engineering -- is a terrible thing to waste.

The Swindle: The Obama administration is spending money like none other in peacetime history. Obama is smart. He knows this is fiscally unsustainable. He has let it be known privately and publicly that he intends to cure the imbalance with entitlement reform.

An excellent strategy. If it takes throwing nearly $1 trillion of "porky" (to quote Sen. Charles Schumer) stimulus spending to soften up a Democratic Congress and make it amenable to real entitlement reform, then fine. Reforming Social Security, Medicare and Medicaid would save tens of trillions of dollars, and make the current money-from-helicopters spending almost trivial by comparison.

In the New Foundation speech, Obama correctly (again) identifies the skyrocketing cost of Medicare and Medicaid as the key fiscal problem. But then he claims that Medicaid and Medicare reform is the same as his health care reform, fatuously citing as his authority a one-day meeting of hand-picked interested parties at his "Fiscal Responsibility Summit."

Here's the problem. The heart of Obama's health care reform is universality. Covering more people costs more money. That is why Obama's budget sets aside an extra $634 billion in health care spending, a down payment on an estimated additional spending of $1 trillion. How does the administration curtail the Medicare and Medicaid entitlement by adding yet another (now universal) health care entitlement that its own estimate acknowledges increases costs by about $1 trillion?

Which is why in his March 24 news conference, Obama could not explain how -- when the near-term stimulative spending is over and his ambitious domestic priorities kick in, promising sustained prosperity and deficit reduction -- the deficits at the end of the coming decade are rising, not falling. The Congressional Budget Office has deficits increasing in the last seven years of the decade from an already unsustainable $672 billion annually to $1.2 trillion by 2019.

This is the sand on which the new foundation is constructed. Obama has the magic to make words mean almost anything. Numbers are more resistant to his charms.

By: Charles Krauthammer is a 1987 Pulitzer Prize winner, 1984 National Magazine Award winner, and a columnist for The Washington Post since 1985.

Source:  TownHall.com/Knowledge Creates Power

Posted:  Daily Thought Pad