Michael Gerson

The trajectory of American debt, by nearly universal admission, is unsustainable. But the cause is not generally admitted on the left. As Yuval Levin points out, our future debt problem is all about health care entitlements. And I mean all. In the Congressional Budget Office's projections, health care costs account for basically 100 percent of our exploding debt in the coming decades.

In about 40 years, health care entitlements -- Medicare, Medicaid, SCHIP and Obamacare -- will overtake spending on everything else in the budget, including Social Security, defense and domestic discretionary spending. The federal government, says Levin, will basically be a health insurer with some unusual side ventures like an army and a navy.

One consequence would be to rule out any broad innovation on domestic policy. To make room for unreformed entitlement commitments, discretionary spending would be so squeezed that even existing programs on education, hunger, poverty and homelessness would be tough to maintain.

For proof, the current budget debate will suffice. Republicans oppose new taxes. Democrats oppose serious entitlement reform. Apparently the only thing on which they can agree is further reductions in discretionary spending, which have already taken the brunt of cuts in the recent past.

More libertarian-leaning Republicans may find this a welcome development -- though it only briefly postpones a deficit reckoning. For Democrats, the matter is more complex. Health entitlements are great liberal achievements, and preserving them is an effective political appeal. But maintaining these past achievements in their current form may preclude the possibility of significant future achievements in the promotion of equal opportunity. An ideology that merely protects the past is not recognizably progressive.

In normal times, a worsening social problem like the wealth gap might unite creative liberals and compassionate conservatives in an unlikely policy alliance. Meetings would take place at the New America Foundation. Bipartisan legislation would be introduced.

It is a Washington I can remember -- but now seems impossibly distant.

Michael Gerson

Michael Gerson writes a twice-weekly column for The Post on issues that include politics, global health, development, religion and foreign policy. Michael Gerson is the author of the book "Heroic Conservatism" and a contributor to Newsweek magazine.
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