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Want to tackle the deficit? Reform health care

President Barack Obama is getting mixed responses to his plan to freeze discretionary spending not related to national security, which he is expected to tout in his State of the Union address Wednesday night. Some conservatives, who have been screaming about the levels of debt the nation is piling up, call it too little, too late. Some liberals, who worry that any decline in federal spending these days could prolong the recession -- as happened when Franklin D. Roosevelt tried to tackle the deficit during the Depression -- say it's too much, too soon.

In truth, the idea is reasonably crafted in so far as it goes. The administration says the president doesn't intend to freeze all agencies but rather to allow spending in some areas, such as energy and education, to increase while others are reduced, and the pledge wouldn't kick in until after a likely jobs stimulus package is approved by Congress this spring, mitigating the effect on policy goals and economic recovery.

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But Republican critics are also right that it won't do much to dent the debt the nation is projected to take on over the next decade -- the White House estimates the plan would save about $250 billion over that period, a time when the federal government is expected to run deficits totaling more than $6 trillion. What Republicans might like less is that in order to really slow ballooning federal spending, what we really need to do is reform the health care system. That's where the money is going.

Between now and 2020, the Congressional Budget Office expects spending on discretionary, non-military items to grow by 3 percent -- not 3 percent a year but 3 percent for the entire decade, from $682 billion to $705 billion. Military spending is expected to grow by about 18 percent, from $690 billion to $813 billion. But spending on Medicare and Medicaid is projected to grow by a whopping 85 percent, from $808 billion to $1.5 trillion.

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The Senate's health care reform bill, which doesn't go nearly far enough in efforts to rein in costs of health care, is projected to reduce spending on Medicare and Medicaid by a total of $440 billion over the next decade. If they care about deficits, Republicans should drop the fear-mongering about death panels and rationing and take the current health reform proposal as a starting point to talk about increasing the use of evidence-based medicine, improving electronic patient records to reduce duplicative diagnostic testing, and switching Medicare from a fee-for-service model to one that pays doctors for keeping people well, not performing medical procedures.

If they did that, they would risk passing important legislation that would strengthen the nation's finances while improving its health while a Democrat was president. But that political risk would pale next to the alternative for making a serious dent in the long-term deficit: Social Security reform. If the goal is reducing the deficit, health care reform seems like a political no-brainer by comparison.

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