As he marked the end of our combat mission in Iraq, President Obama on Wednesday night quite rightly used the moment to deliberately refocus national attention on how we have “spent a trillion dollars at war, often financed by borrowing from overseas and short-changed investments in our own people.” This was not intended to throw cold water on what might, in other administrations, have been a decidedly more mission accomplished, made for campaign season, moment complete with aircraft carrier and flight suit. Rather, the Commander in Chief’s remarks remind us that as we begin to come home from fights abroad, a challenge no less daunting than Middle East terror continues to plague us on our own soil. It’s the economy stupid, but we can win here too.
As we begin to extricate ourselves over the next months and years from Iraq and Afghanistan, now is the time to take stock of where our financial priorities have been, and seize the opportunity to reinvest against our own domestic vulnerabilities. Weighing in at over $700 billion the US defense budget for this year dwarfs our fourteen nearest competitors combined. Not to put too fine a point on it, but that translates to the US comprising 46% of global defense spending against Russia’s 3.5% and China’s 6.6%. This is not spare change given that the federal deficit is estimated at $ 1.4 trillion for FY2010, but it is arguably alarmist, unless you expect the whole rest of the world to align against us in the next year or so.
Among our many very real domestic threats however, is the burden of health care spending on our citizen-consumers and businesses. Even if we choose to ignore for a second the millions of uninsured Americans and the financial ruin that awaits if they get seriously ill or injured, reality is that those of us who are insured, and employers both large and small who generally guarantee that insurance, are not safe either in the face of higher and higher health insurance premiums coupled with less and less coverage. Either way you look at it, this is yet another form of bloodletting from our middle and lower classes, whose anemic spending will ultimately thwart job creation and be the undoing of any recovery plan from either side of the aisle regardless of what happens in November.
And while politicians gear up to proclaim campaign promises broken or fulfilled, I for one am grateful for even imperfect victories here at home, particularly on behalf of my patients. Health care reform under the Affordable Care Act (ACA) goes a long way toward investing in increased access to increasingly scarce primary care, medical education, more efficient medical record keeping, cost/life saving preventative medicine, as well as reining in insurance industry abuses and runaway premium hikes which do nothing to improve access or outcomes. The ACA introduces some much needed competition into an otherwise monopolistic marketplace, and I hope it is only a taste of things to come as the American people and its businesses realize the benefit of this reform - seeing their own health care spending go down and discretionary spending go up.
On balance health care reform is a potent weapon and a smart investment against the enemy of financial ruin here at home at a historic moment when we should be reevaluating our priorities.