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By DAVID ROGERS | 4/8/11 8:32 PM EDT Updated: 4/9/11 9:49 AM EDT

The bottom line to Friday night’s spending deal is a record $40 (sic) billion cut in domestic and foreign aid appropriations – and a hard lesson in the tough and almost permanent disorder of Washington’s budget politics.

Impressive — Republicans and Democrats actually agreed to the largest cut in spending in U.S. history. However, sadly, there is a staggering counterpoint to this moment of accomplishment and political credit taking:
We experienced weeks of high drama and threats of a government shutdown over spending cuts that are equivalent to about nine days of budget deficit neutral spending.  Yes, our deficit increases on average about $4.08 billion each day.  That is how big, that is how bad, our deficit crisis has become.

Now, we move on to the real battle — serious reductions in spending in a way that hopefully will not wreck the fragile economic recovery and severely cripple the healthcare delivery industry. 

Rep. Paul Ryan, Chair of the House Budget Committee, has defined this debate with the submission of his budget proposal.  As I have written in the past, you may not agree with Mr. Ryan's budget plan — Paul Krugman, Princeton's Nobel Laureate in economics and New York Times columnist certainly does not — but he at least has had the political courage to acknowledge the problem and to propose a correction.
As healthcare leaders, we must now focus on this problem because it is not healthcare reform that will change or wreck our lives as we know them today, but the deficit crisis and the fact that Medicare spending will be the biggest issue in this seminal debate over our country's future.

Consider this:  two 56-year-olds with average earnings will pay $140,000 in dedicated Medicare taxes over their lifetimes.  They will receive $430,000 in benefits,  conservative columnist David Brooks wrote in the Friday New York Times.  It is not important whether you agree with Mr. Ryan's approach, the math simply does not work, and that leaves us with only one course of action: we must reform this entitlement program in a way that we cure this acturial imbalance.

I do not have the answers, but I do believe that healthcare leaders — physicians, hospital executives and insurers — can craft a solution that will work far better than anything that comes from Congress, which took weeks of high drama just to agree on cuts that will yield only nine days of deficit neutral spending over the next six months.

This was, as Politco reported, "a hard lesson in the tough and almost permanent disorder of Washington’s budget politics."

© 2011 John Gregory Self

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