Budget Reality
Part 2 - The Military Budget
The military budget prior to 9/11 was under 300 billion a year. This core budget now is over 500 billion, and when the costs of Iraq and Afghanistan are added, the total is nearly 700 billion this year. This increase of 400 billion a year has never been paid for, adding another 3-4 trillion to the national debt over the past ten years.
Has the increase in the core military budget made us stronger and safer? Not much evidence in favor. Would we be fatally weak if the core budget shrank by 100 billion to 400 billion a year, still the biggest military budget in the world by far? Shouldn't we pay for the Iraq and Afghanistan occupations, rather than pass on the costs to our children? Isn't this the moral thing to do? Simply put, shouldn't we pay-as-we-go for our national security?
If we are serious about the budget, then we need a Security Surtax to pay for the military, and to pay back the costs of the last ten years: say 100 billion this year, adding 100 billion each year for the next six years. The surtax would be phased out as Iraq and Afghanistan phased out. Even this would add another trillion or so to the debt, before reducing it.
Next, health care costs...
Budget Reality
Part 3 - Health Care Costs
National health care costs continue to increase without limit, and neither party has proposed effective controls. This is the third "third rail" of our political system, not to be touched for fear of the consequences to the parties.
The health care system is too complex to find only one or two areas for action which will solve the problem. Nonetheless, here are a few steps which could begin moving in the right direction.
A. Doctors who receive federal funds or reimbursements need to be on a fixed salary, like the civil service system. This would eliminate the piece-work incentive they now have to perform more procedures to increase their income. And, referrals to clinics or laboratories in which they have financial interests have to be banned, as the conflicts of interest they are.
B. We need more doctors and medical professionals, to improve services in urban areas, poor communities and rural towns. We should finance medical educations for those who agree to serve the under-served for a period equal to their medical education years.
C. Hospital and clinical overhead needs to be reduced to no more than 15%. This will take some study and some time, but is essential.
D. Most important, and most dangerous to touch, is changing the concept that we all are entitled to every possible medical procedure without limits. No society can afford to promise unlimited medical benefits, but whenever this subject is touched, the cry of "rationing" fills the airwaves. This is both false and misleading. "Rationing" is about distributing resources which are in short supply. We don't have a short supply of medical resources in the U.S. It may be too expensive, unequally distributed, and often ineffective, but it is abundant.
The question is not whether we all want unlimited benefits, but whether we can afford unlimited benefits. The answer is "no." We can't afford to promise unlimited benefits.
So, the real question is how to set fair limits for medical care.
Should we pay tens of thousands for cancer drugs to extend life by a few months for someone in their 80's? Should we pay for most prescriptions for erectile dysfunction drugs for otherwise healthy men? Should there be a lifetime dollar or procedure limit for each of us? Should we pay for lung cancer treatments for long-term smokers? Each of these examples is a medical, ethical and budgetary question.
The answers are not clear, but the need to ask the questions and to find the answers is essential. We need to act like adults and face these questions through an open and public process. It is time to get real on controlling health care costs, even if it affects some one's profits. In the meantime, we need to set limits on the growth of health costs, and let the private sector sort out how to comply with these limits.
Next, corporate tax breaks...