In his column this morning on the centrality of healthcare spending cuts to President Obama’s plans David Brooks makes a point I’ve been making around here for some time:
The likely outcome of this year’s health care push is that we will get a medium-size bill that expands coverage to some groups but does relatively little to control costs. In normal conditions, that would be a legislative achievement.
But Obama needs those cuts for his whole strategy to work. Right now, his spending plans are concrete and certain. But his health care savings, which make those spending plans affordable, are distant, amorphous and uncertain. Without serious health cost cuts, this burst of activism will hasten fiscal suicide.
This is a conundrum that most recent presidents have faced. For example, President Reagan talked a good fiscal show but while Congress was happy to enact his tax cuts (well, happy after some prodding) and defense spending increases the increases were never matched with cuts and they rejected nearly any spending cut when his administration proposed them. None of the Reagan budgets were balanced. The president proposes, Congress disposes.
