The House GOP proposes to break the back of America's gross indebtedness by starving Big Bird, Planned Parenthood, the EPA (guardian against mercury contamination), the IRS (guardian against tax cheats), the USDA (guardian against e. coli), and money for a park in Nancy Pelosi's district.
At the last minute, an Arkansas GOP congressman withdrew his proposal to cut funding for the president's teleprompter. Tax breaks for the oil industry will remain. Also aid for Israel (one of the wealthiest of aid recipients). And the Defense Department's budget to sponsor Nascar racers. Never mind that auto racing's popularity is in decline, and the Pentagon sponsorship is a recruiting tool the Navy and Marines decided some time ago to scrap for lack of efficacy.
So John Boehner is lying when he says, "Everything's on the table. We're broke."
The whole budget debate, then, is a sham. House Republicans, in particular, are literally stealing food from the mouths of babes - nutritional aid to pregnant women and very young children is one of the items on their cutting block - so they can pose, falsely, as deficit hawks.
What would a serious approach to our fiscal problems involve? I can summarize it in seven words: health care, health care, health care, revenue. ...
What would real action on health look like? Well, it might include things like giving an independent commission the power to ensure that Medicare only pays for procedures with real medical value; rewarding health care providers for delivering quality care rather than simply paying a fixed sum for every procedure; limiting the tax deductibility of private insurance plans; and so on. [The latter - known as "gold-plated" or "Cadillac" insurance plans - are paid for by customers of the corporations offering them to their most exalted hands, and by Main Street taxpayers who fund this tax break when corporations report the cost as an eligible tax deduction.]
And what do these things have in common? They're all in last year's health reform bill.
That's why I say that Mr. Obama gets too little credit. He has done more to rein in long-run deficits than any previous president. ...
This brings me to the seventh word of my summary of the real fiscal issues: if you're serious about the deficit, you should be willing to consider closing at least part of this gap with higher taxes. ... We should add to the roster of fundamentally unserious people anyone who talks about the deficit - as most of our prominent deficit scolds do - as if it were purely a spending issue.
Reagan, Bush 41, and Clinton all raised taxes. And the U.S. economy thrived as never before. And, of course, for the first time since the 1970s, Washington began posting budget surpluses by the late 1990s.
Obama also is not credited for his three tax breaks in just two years in office, skewed to middle-class and low-income families. He has allowed Obamacare to be depicted as an added burden to the taxpayer, when it is just the opposite. Obamacare is a package of cost-reduction initiatives that is America's best hope for restoring the nation's finances. Too bad it wasn't sold that way. Or really, sold at all.
Krugman is calling here for a sensible twin-track strategy of cutting government costs and raising revenues. Obamacare will save money while improving care. (More on methods for that below.) But it needs to be accompanied, on the revenue side, with modest tax increases of the same modest size that Clinton imposed on the richest Americans in his 1993 budget. That landmark budget, which passed without a single GOP vote (Gingrich warned it would throw the U.S. into deep recession), culminated in surpluses and the creation of a record 23 million new jobs.
Much of what one needs to know about innovative health care solutions has been, and continues to be, chronicled by Atul Gawande, a contributing writer at the New Yorker who somehow also manages to keep up with his duties as an endocrine surgeon at Boston's Brigham and Women's Hospital and an associate professor at Harvard.
Recall that Gawande last year discovered that identical health care services were priced wildy apart, not only between Minnesota (reasonable) and Texas (grossly over-priced), but between neighboring towns in Texas. It was at that point that Gawande became required reading at the WH.
Gawande's latest field report describes healthcare pioneers who identify the sickest people in a community - the 5% of people accounting for 60% of local health care costs. These people are provided an "ambulatory ICU" of attentive care and help in changing unhealthy behaviors. The health of the patients improves by significant measure, while their emergency-room visits - previously scores of them per year for many individuals - falls sharply. Of course, ER visits are the costliest means of delivering care. Here's Gawande's latest report and his reply to reaction to it elsewhere.
Bottom line: Health care, despite accounting for roughly one-fifth of the U.S. economy, has resisted reform more stubbornly than any major institution in society - more even than post-secondary education, which is notoriously slow to embrace change. If wrenching reforms had been attempted and still health care costs have skyrocketed, that would be sobering indeed. But the good news is that reforms have not been attempted, save for minor initiatives around the edges. The good news is that America needn't become insolvent by mid-century while more thoroughly caring for its people.
And America can afford another park for San Francisco.