Saturday, April 25, 2009

Obama: The Grand Strategy


Obama: The Grand Strategy
Charles Krauthammer
Friday, April 24, 2009

WASHINGTON -- Unified theory of Obamaism, 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 a myriad of 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' 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.


Copyright © 2009 Salem Web Network. All Rights Reserved.

1 comment:

Superb Jon said...

Obama marks the end of the Burke Maritan Buckley model of conservatism based on collectivist labor unions, police suppression of the Bill of Rights, middle class subsidies for homes and schools under the watchful eye of Knights of Columbus, Opus Dei and the East Side Conservative Club. They had no qualms hijacking American policy in Vietnam or Balkans to papal ends, but when American interests opposed tose of the papacy in Iraq, they showed their true fangs (Frum, Unpatriotic Conservatives). They broke their own coalition with their foreign adventures and with their unwillingness to extend home and school subsidies to other races, as evidenced by their missing their own Obama moment when they could have elected a Kenyan pope. Every American boom has been caused by an Evangelical Revival and every major Depression by the domination of new Catholic immigrants. See for example George Marlin's history of the conservative party in New York or Paul Johnson's Modern Times, extolling the rise of Carolignianism of Adenauer, de Gaulle, and Gaspieri, forgetting that Hitler, too, was Carolignian and a Catholic altar boy. Carolignian Brzezinski spawned Zia al Haq, Khomeini, and bin Laden - breaks up superpowers via Aztlan and Kosovo as per Joel Garreau's Nine Nations. Brzezinski, Buckley and Buchanan winked anti-Semitic votes for Obama, delivered USA to Pope's feudal basket of Bamana Republics. Michael Pfleger and Joe Biden prove Obama is the Pope's boy. Obama is half a Kearney from County Offaly in Ireland. Talal got Pontifical medal as Fatima mandates Catholic-Muslim union against Jews (Francis Johnson, Great Sign, 1979, p. 126), Catholic Roger Taney wrote Dred Scott decision. John Wilkes Booth, Tammany Hall and Joe McCarthy were Catholics. Now Catholic majority Supreme Court. Catholics Palmisano, Grasso, Damato, Langone, Dioguardi, Palmieri destroyed American industry. Subprime construction mobsters had hookers deliver mortgages to banks. McCain's Keeting started it all. They find American cars too advanced to use or their mechanics to fix. Their slovenly, anti-intellectual work ethic produces vacuous, casuistrous blather and a tangle of contradictory regulations. NYC top drop outs: Hispanic 32%, Black 25%, Italian 20%. NYC top illegals: Ecuadorean, Italian, Polish. Ate glis-glis but blamed plague on others, now lettuce coli. Their bigotry most encouraged terror yet they reap most security funds. Rabbi circumcises lower, Pope upper brain. Tort explosion by glib casuistry. Hollywood Joe Kennedy had Bing Crosby proselytise.Bazelya 1992 case proves PLO-IRA-KLA links. Our enemy is the Peking-Mecca-Vatican Axis and the only answer is alliance with Israel and India.