Word: costs
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...make the assumption that because it often makes social interactions go more smoothly, lying is O.K. But there is a cost to even seemingly benign lies. If people are always telling you that you look terrific and you did a great job on that presentation, there's no way to have an accurate understanding of yourself. Lies put a smudge on an interaction, and if it's easy to lie to people in minor ways, it becomes easier to lie in bigger ways...
This is why Obama and his budget director Peter Orszag are so eager to "bend the cost curve" for health care - if they don't, it's hard to see how we're going to be able to afford a military or interstate highways or a social safety net or any other government services. Compared to health costs, the Iraq war, the financial bailouts, the stimulus package and even the long-term Social Security shortfall are minuscule fiscal problems. (See a guide to understanding the health-care debate...
...these days, Obama isn't saying much about cost-cutting. This is partly because most of his curve-bending ideas - computerized records to bring medicine into the 21st century, comparative effectiveness studies to identify unnecessary treatments, revamped incentives to reward quality rather than volume of care - would take more than a decade to start slashing costs, and the Congressional Budget Office (CBO) doesn't score bills for their impact on the federal deficit that far in advance. Obama's most prominent game changer - an independent panel to set Medicare reimbursement policies removed from political pressures - did not fare well under...
Politics, of course, is the main reason Obama is trying to sound more like Santa and less like the Grinch. Cutting costs ultimately means cutting payments to drugmakers, hospitals, doctors, insurers and other influential health lobbies, so it's understandable that he hasn't dwelled on it. Providers like the Mayo Clinic have demonstrated the promise of high-quality, low-cost care, and mounds of research as well as books like Shannon Brownlee's Overtreated have documented Orszag's less-would-be-better thesis. But to laymen it can still sound like typically empty government promises to weed out waste...
There are those who caution against a jobs program. Heritage Foundation scholar Brian Riedl is skeptical about the benefit. "Every dollar that Congress injects into the economy must be first taxed or borrowed out of the economy," says Riedl. "The jobs we create in one county come at the cost of jobs in another county. It is a zero-sum game." Riedl believes there are times when government action is called for on humanitarian reasons. But in terms of economic growth, he says, "the only government spending that creates a net bonus for the economy is spending that results...