Health Care and the Debt-pocalypse

More and more, one single truth about America's national debt is becoming clear: If we don't want an unsustainable increase in our debt level, we must cut federal health care spending. A lot.

Brad DeLong reiterates this point:

In short, if we want to do as much harm to the long-term budget picture as we did good by passing [Obama's health care bill], we would have to spend $8 trillion on additional stimulus. The effects of fiscal stimulus spending now on our long-term budget position are lost in the rounding error.

The reason, of course, is that the big drivers of the long-term deficit are the excess above GDP projexted growth rates of Medicare and Medicaid. Put in place institutions that slow the long-term growth of Medicare and Medicaid--as the CBO believes the [Obama's health care bill] does--and you do infinitely more to improve the long-term budget picture than any stimulus program could possibly do to harm it.

As you can see, except for the brief bump caused by the stimulus, federal discretionary spending has held steady or shrunk as a percent of GDP. It is also apparent that Social Security is not in trouble; payments are headed for only a modest rise as the Baby Boomers retire, a rise that could be completely counteracted by ending the income cap on payroll taxes and raising the retirement age by a year or so.

So basically all of the huge projected growth in federal spending comes from Medicare and Medicaid. We have two choices to avoid a sovereign default: raise taxes enormously to cover this cost, or enact deep cuts in Medicare and Medicaid.

I strongly dislike the first option. Though in general I support taxing the public to pay for public goods, I don't think most of this health care spending qualifies. First of all, health care is mostly a private good, meaning that the benefits of health care spending mostly accrue to the person the money gets spent on. That reduces the economic rationale for having the government pay. But even more importantly, health care is a sector with low and decreasing productivity; most of that new money we're spending isn't giving us better health. Why distort our economy with higher taxes just to throw the money at unnecessary treatments, procedures, and fees?

I supported Obama's health care bill because it came up with a bunch of ways to control costs (some of which could be expanded in the future if they work), and by making health care universal it enabled the broad political coalition that will be necessary to cut health spending in the future. But the reality is, health spending needs to be cut, and cut big. If we do this now, we can call it "restraining the growth of Medicare and Medicaid spending." If we wait, we'll have massive government and social breakdown as old people pull out all the stops to save their health care from the draconian slashing that will by then be necessary.

So we had better start slowing Medicare and Medicaid down right now. This may sound like a political non-starter for the Obama administration, but I think it could actually be a good move; if Obama shows all the austerity-freaks and deficit hawks out there that he is serious about long-term deficit cutting, they'll be more inclined to accept short-term measures like the recently defeated jobs bill.

But, one way or another, Medicare and Medicaid must be cut, and cut big. We have no other option for averting the Debt-pocalypse. None.