You’ve seen it on 1000 websites by now: Jan Brewer’s long, awkward pause during her opening remarks in the gubernatorial debate in Arizona. That’s a little bit embarrassing, I suppose, especially considering that those were her prepared comments. Really, though, so what? We all get tongue-tied, and for most of us we don’t have live television cameras pointed at our face to increase the pressure. I hardly think her brief confusion says anything about her qualifications for re-election.

Here’s what I find astonishing, though. Moments before her stumble, she proclaimed, “We have cut the budget. We have balanced the budget.” WTF? No, “we” haven’t. According to the state’s own reports, if you take out the budget tricks, the budget shortfall in the current FY2011 will be $1.691 billion (see page 17). That is 20% of the state’s total spending. The deficit remains in the $1 to $2 billion annual range in the projected years ahead.

To be perfectly fair, the actual budget deficit in FY2011 is projected to be between “zero and $1.2 billion,” which is a better picture than the structural deficit of $1.691 billion, and which may provide Gov Brewer with a technically defensible claim to balancing the budget. What is the difference between the two projections? Two things. One is federal stimulus money, and the other is the governor’s sales tax increase, which lasts for three years. Do y’all hear what I’m saying? The only reason the governor can lay even a remotely plausible claim to balancing the budget is federal stimulus money and a tax increase. That’s right: federal stimulus money and a tax increase. One more time:  federal stimulus money and a tax increase. Tea Party people, take arms!!!

The media? They think the important news here is 13 seconds of dead air.

There are only two possibilities, mathematically speaking — either we have a balanced budget, or debt goes up. Can people of all political stripes agree on that?

Here is my question to my friends on the conservative end of the spectrum. Assuming that continuously increasing debt is intolerable, we must balance the budget, right? Okay, how do we accomplish that? There are only two variables in the balanced budget equation: spending and taxation. But you flatly reject taxation as a solution. So that leaves us trying to balance the budget ENTIRELY through spending cuts. With the deficit running at $1.3 trillion annually, we would need spending cuts in that amount to balance the budget. I would be curious just what cuts you have in mind of that magnitude. If you cannot cut $1.3 trillion in spending, and if we cannot raise taxes, then how is it mathematically possible to balance the budget? And if you cannot balance the budget, are you not advocating for for increased federal debt? The math is inescapable.

Here is my question to my friends on the liberal end of the spectrum. This is a breakdown of Obama’s FY2010 budget:

Mandatory spending: $2.184 trillion (+15.6%):
$695 billion (+4.9%) – Social Security
$453 billion (+6.6%) – Medicare
$290 billion (+12.0%) – Medicaid
$0 billion (−100%) – Troubled Asset Relief Program (TARP)
$0 billion (−100%) – Financial stabilization efforts
$11 billion (+275%) – Potential disaster costs
$571 billion (−15.2%) – Other mandatory programs
$164 billion (+18.0%) – Interest on National Debt

Discretionary spending: $1.368 trillion (+13.1%):
$663.7 billion (+12.7%) – Department of Defense (including Overseas Contingency Operations)
$78.7 billion (−1.7%) – Department of Health and Human Services
$72.5 billion (+2.8%) – Department of Transportation
$52.5 billion (+10.3%) – Department of Veterans Affairs
$51.7 billion (+40.9%) – Department of State and Other International Programs
$47.5 billion (+18.5%) – Department of Housing and Urban Development
$46.7 billion (+12.8%) – Department of Education
$42.7 billion (+1.2%) – Department of Homeland Security
$26.3 billion (−0.4%) – Department of Energy
$26.0 billion (+8.8%) – Department of Agriculture
$23.9 billion (−6.3%) – Department of Justice
$18.7 billion (+5.1%) – National Aeronautics and Space Administration
$13.8 billion (+48.4%) – Department of Commerce
$13.3 billion (+4.7%) – Department of Labor
$13.3 billion (+4.7%) – Department of the Treasury
$12.0 billion (+6.2%) – Department of the Interior
$10.5 billion (+34.6%) – Environmental Protection Agency
$9.7 billion (+10.2%) – Social Security Administration
$7.0 billion (+1.4%) – National Science Foundation
$5.1 billion (−3.8%) – Corps of Engineers
$5.0 billion (+100%) – National Infrastructure Bank
$1.1 billion (+22.2%) – Corporation for National and Community Service
$0.7 billion (0.0%) – Small Business Administration
$0.6 billion (−14.3%) – General Services Administration
$19.8 billion (+3.7%) – Other Agencies
$105 billion – Other

Why must we have a 13.1% increase in discretionary spending? Isn’t that the height of irresponsibility in these times? The economy is booming again. The stock market is up by 60% in the past year. The massive job losses  of 2007-08 have ended, and all signs point to job creation around the corner as the economy continues to expand. Surely we can have a budget that acknowledges the economic drag that $1.3 trillion annual deficits, and $13 trillion of cumulative federal debt, have.

No matter how I look at things, I come back to the same conclusion. Ideologues are America’s greatest enemy.

The WSJ is reporting two bits of good news this morning. One, industrial production rose 0.8% in August, following a 1.0% rise in July. Both results exceeded analysts’ expectations. Fed Chairman Bernanke is now making pronouncements that the recession could be over. The second news item was that inflation remains very low. We have seen the stock markets increase by, what, maybe 35% since the bottom was hit earlier this year?

What I don’t get is how this is happening in the face of various government actions that have garnered scathing criticism from some quarters, and deep concern from many other quarters. The view advanced by many is that towering federal deficits, massive government intervention to rescue the financial markets and auto companies, the stimulus package, and worries over the cost of the healthcare reform legislation should be shaking our economy to its core.

 But that just doesn’t seem to be happening. How do we make sense of this? Do we trust the markets to give us an objective assessment of our actions? Were the doomsdayers off base? Did it turn out that the ocean of our economy was big enough to absorb and dilute the economic pollution from these governmental actions? Whatever the explanation, critics of the Administration need to take note of these positive indicators.

· Cut the amount that America spends on healthcare in half.

· Provided universal health insurance coverage. Yep, 100%.

· If you have a serious illness, such as cancer, paid 100% of the costs of treatment.

· Used the private market to deliver all healthcare, including an option for doctors and others to opt out of participating in the government-funded plan. Retained the fee-for-service arrangement that dominates US healthcare system now, to minimize disruption. Provided doctors with greater independence in diagnosis and treatment than the European model.

·  Reduced infant mortality by 40%; raised life expectancy; lowered mortality rates from preventable diseases.

Would you support a plan like that? Welcome to France. If you would not support that, why not?

http://www.npr.org/templates/story/story.php?storyId=92419273

http://www.nationaljournal.com/njmagazine/wn_20090718_3933.php

Being one who is always willing to oversimplify an issue, if not this healthcare reform, then what? I am curious what is the appetite for the status quo? All polite responses are welcome.

Somewhere along the line, the inside-the-beltway debate has lost sight of the real mandate that we sent a new crop of elected officials to Washington to pursue: to provide a stable means of access to decent health care for the tens of millions who lack it.

The status quo fails vast numbers of Americans. Obviously, many millions simply lack insurance, and the problem starts right there. They are forced to rely on a costly and ineffective hodge-podge of solutions. Famously, our most expensive care-giving mechanism, emergency rooms, is used to provide basic care. Hospitals write off that bad debt and recoup the cost through higher insurance premiums on the rest of us. Or, people get themselves to a doctor, but then fail to take the expensive medication or get the follow up treatment. Health issues accumulate, and costs spiral higher still.

People fail to have insurance for a lot of reasons. Some people make too much money to qualify for Medicaid but not enough to afford insurance. Employers who rely upon low-paid workforces cannot remain competitive if they try to provide health insurance benefits costing $500 a month to people who make $1500 a month. Insurance companies somehow have settled on this practice of pre-existing conditions — perhaps not fully considering that, while they may avoid insuring the next unwell person, they also are retaining the current unwell person, who now cannot leave his job. Or, a person is stuck with sky-high COBRA premiums. Or simply is young and thinks herself immortal and unwilling to insure the risk of medical expenses.

Whatever all the causes, the status quo is clearly askew beyond all measure. We need only reflect on the often-repeated refrain that the US spends the most money in the world to achieve average, at best, health.

So, back to the mandate. How do we provide a stable means of access to decent health care for the tens of millions who lack it?

1. Cost containment. Without this, we cannot both provide access to all and not break the bank. But where is this in the Washington debate? Neither party in Congress is offering any clear-cut cost containment strategies. Democrats have taken taxation of health benefits off the table. Without that, the CBO says, people have no incentive to moderate consumption of healthcare. They also have taken tort reform off the table, another aspect that some analysts believe could hold down costs. Republicans are behind tort reform, but are offering nothing beyond that whatsoever, and tort reform is a small piece of the package. It’s like going on a diet by giving up sprinkles on your donuts.

2. Universal access. Forget about private versus public. One way or another, access to stable healthcare is the moral imperative here. Republican ideas are focused around helping people buy insurance by offering tax advantages for doing so. Not only does that smack of the recently exposed federal mortgage policies (which, oddly, Republicans have denounced, while advocating a nearly identical policy for healthcare — huh??), but also it fails to address the issue. The people who lack insurance skew hugely to the lower income population. These are people making $1500 to $2000 a month. Health insurance for a family of four costs $500, $600, $1000 a month. Giving a tax break worth 15% of that cost hardly puts it within reach. Democrat proposals are better in terms of access, but still will leave many millions on the outside looking in.

Here is what I wish we would hear from President Obama: “I will veto any plan which fails to provide health insurance to all Americans. This may be private, public, or a combination of both. I will veto any plan which increases the nation’s total expenditures on healthcare. Government spending may go up or down, private spending may go up or down, but the total of the two must not increase. Congress, keep working until you have a plan that fits those two simple — but devilishly challenging, I am sure — guidelines. Other than these two parameters, nothing is off limits.”

Hopefully Obama would allow lots of room for Congressional debate, within these parameters. Taxing benefits is not off limits; if healthcare spending does not increase, then by definition whatever Americans pay in taxes for it will be offset by decreased outlays in other ways. Tort reform is not off limits. Reforms of existing health insurance plans is not off limits. How about we scrap the entire costly, antiquated and ineffective VA medical system, and simply issue Medicare cards to all veterans (why do we have a whole separate healthcare system for that purpose, anyway???). How about we allow doctors to make any medical decision they wish to, but we lessen the payment when that decision is contraindicated by large-scale studies? (In other words, go ahead and get the unnecessary Caesarean section if you want to, but don’t expect your insurance company to pay more than it would for a routine delivery.)

That is to say, dig deep, be truly creative, be bold and innovative. The very worst part of this whole debate is that it is mired in staleness, mired in the dismal workings of Congress and government. But it doesn’t have to be that way. In fact, I venture to say, we elected President Obama precisely because he reminded us that it doesn’t have to be this way. So, Mr. President, go punch Congress in the freakin’ nose and get this right.

I have been having a very thoughtful exchange with another blogger about these tea parties, and what they represent. It finally dawned on me why I am vaguely mistrustful of the tea party movement, even though I support its basic message. I suspect I differ from most tea-party folk in terms of our understanding of what the ramifications of such a movement will mean.

Much anger is directed at frivolous, wasteful and excessive spending. By all means, let’s light the torches and demand an end to all that. But, once all of that has been taken away — all the Congressional perks, all the earmarks, all the unambiguously pork projects — what do we have? An annual deficit of maybe $700 billion instead of $1 trillion.

People have to be ready for the cold, hard reality that this means large-scale reductions in government services. This may mean that Social Security and Medicare start at 68, not 65. And that grandma has to live in the spare room instead of the nursing home, due to Medicaid cuts. And that I have to fork over $700 for a laptop for my highschooler, because the schools don’t have enough computers. And that expressways become tollways because of cuts in federal transportation funding. And that food plants are inspected less often. And that national parks are closed from November through March. And that we withdraw precipitously from Iraq and Afghanistan. And that the cost to ride Amtrak or mail a letter goes up by 50%.

The list is endless, and more importantly, it isn’t painless. In fact, it will be extremely painful.

Government may be broken, but WE broke it. Candidates told us we could have all these services, and pay less in taxes, too! Glory be! Sign me up!!! We got exactly what we asked for.

There was no betrayal, except of ourselves, by ourselves. We are not the victims, we are the perpetrators. And the pain of restoring order will be our pain, not theirs. I pray that people get that.