David Brooks at the New York Times warns that our preferences for health care spending and for global power are about to collide:
So far, defense budgets have not been squeezed by the Medicare vice. But that is about to change. Oswald Spengler didn’t get much right, but he was certainly correct when he told European leaders that they could either be global military powers or pay for their welfare states, but they couldn’t do both.Europeans, who are ahead of us in confronting that decision, have chosen welfare over global power. [ . . . ]The United States will undergo a similar process. The current budget calls for a steep but possibly appropriate decline in defense spending, from 4.3 percent of G.D.P. to 3 percent, according to the Congressional Budget Office.
Brooks underlines the point we made recently that severely cutting back health care services to Americans is not an option. If we don’t figure out a way to make the health care system cheaper and more effective, the cost is going to be crushing—not just in terms of schools, infrastructure, and all the other good things government does at home, but in hollowing out the U.S. military in ways that will hugely increase the danger of major and minor wars across the world:
As the federal government becomes a health care state, there will have to be a generation of defense cuts that overwhelm anything in recent history. [ . . . ]As this sort of crunch gradually tightens, Medicare will be the last to go. Spending on things like Head Start, scientific research and defense will go quicker. These spending cuts will transform America’s stature in the world, making us look a lot more like Europe today. This is why Adm. Mike Mullen called the national debt the country’s biggest security threat.
Read the whole thing here. Brooks’ column squarely faces up to the dire straits we are in. America badly needs a transformative approach to health care that can radically increase the productivity and effectiveness of this economic sector. Without that almost everything we do consists of moving deck chairs around on a sinking ship. Obamacare has its virtues, but as a system it does more to lock us into an unsustainable model than to pave the way for transformation. The fight for a sustainable health care system has yet to begin.