I've been seeing a number of op-eds in recent defense journals that have a slightly hysterical, paranoid perspective on the "dangers" of health care
March 9, 2010

I've been seeing a number of op-eds in recent defense journals that have a slightly hysterical, paranoid perspective on the "dangers" of health care reform. The authors of these articles are terrified that mounting costs of health care are going to impinge on the defense budget. Democrat attempts to give all Americans insurance may increase overall health care costs. As a result, a weakened America will be just wide-open to attack by terrorists and China and who knows what else. Think I'm exaggerating? Here's Harvey Sapolsky, a defense academic out of MIT, talking in the National Defense journal.

The defense spending squeeze is on and will become more constricted by health care reform. It is not apples and oranges. About half of the United States’ health care costs appear on the federal government’s budget, which directly affects revenues and expenditures. European nations plead poverty when it comes to funding their militaries in large part because of the squeeze of social spending (including health care). They spend a smaller, though rising, share of their GDPs on health than does the United States, but more of that spending is direct government expenditure.

If heath care can’t be made more efficient and if access to health care can’t be limited, the only alternative is more revenue. Perhaps taxes will be raised. Some will be increased, but not likely enough to cover rising health expenditures. Democrats promise to only tax the rich. But, as the rich know, tax laws have loopholes. Republicans have run for years on a tax-cutting platform. The way to get revenue is to tax the middle class who are many and who are not as fleet of foot as the rich. But both Republicans and Democrats constantly say the middle class is the victim of everything, and surely overtaxed. Running up the deficit is an alternative, but the wars, the stimulus plan and the bailouts have already done that. The cries for controlling spending are already being heard.

The revenue for more health care exists in the form of defense expenditures, which have doubled since 9/11. The billions needed for reforming health will likely come, in one way or another, from cuts in defense spending. Personnel reductions will be hard to make because of the burdens that Iraq and Afghanistan deployments place on U.S. forces. Fewer and fewer aircraft and ships will be bought. There will also be less training and more restrictions on operations with and for allies. America has a powerful military that will take a while to unravel, but unravel it will. The nation’s defense budget is about to tangle with a really dangerous adversary.

Sapolsky's article is actually one of the more sane pieces that I've read. He at least argues for the urgent need for health care reform, least its uncontrolled growth threaten defense spending. He does note that the defense budget has become an attractive target because of its enormous, unchecked growth (you rob banks because that's where the money is). But I think that he (and others) suffer under a number of false assumptions - notably, that health care costs cannot be restrained, the general perception that the defense budget has grown too large, Democrats like health care and hate the military, therefore, the defense budget will suffer cuts to allow the continued growth of health care.

However, the conclusion is limited by its bad assumptions. There is no question that the health care industry can use a healthy dose (no pun intended) of reform, and Medicare/Medicaid will eventually need to be examined in depth as well for reform. Maybe every senior citizen doesn't need a motorized wheelchair (gasp!). Similarly, the need for defense acquisition reform is well documented, despite numerous failed attempts to correct bad practices and to encourage the services to moderate their demands for high-tech, gold-plated defense platforms.

The challenge is that any reforms to either health care or the defense acquisition processes will impact Big Business hard, and it has gotten fat and happy over the past decade. With the recent Supreme Court decision allowing Big Business to buy politicians, it's going to be increasingly hard to reform either health care or defense acquisition. Not that it was easy now - with the Republican party of "NO," continued obstructionism in Congress will ensure that no tough decisions are made - rather, the politicians will favor incremental steps towards reform as long as they are firewalled from blame or implication to any budget cuts.

The cries of doom from the defense journal op-eds are misguided. No one is going to cut defense funds until the pace of military operations in Afghanistan and Iraq changes to allow for a drawdown on operational spending. That doesn't involve any changes to the ridiculously out-of-control acquisition process, unfortunately, but that makes it easy for both Democrats and Republicans. Similarly, no one is going to seriously address mounting health care costs as long as there is no change in willingness to add debt to the federal deficit. I used to hope that a new generation of politicians, replacing the grey, old white men in the House and Senate, might cause change, but that's probably too optimistic.

UPDATE: Rob Farley tears down Sapolsky's argument in detail, where I only pointed to the general failure of the "we can't have both health care and defense programs" argument.

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