"We are eating our seed corn." -- Marian Wright Edelman, Children's Defense Fund, 2009
WASHINGTON -- President Barack Obama started the adult conversation over debt and taxes last week -- if only barely. In a forthright and feisty speech, Obama defended the traditional social safety net while also acknowledging the need to curb the growth of spending, especially on health care.
But he riled many Republicans by reintroducing an inconvenient truth: Taxes must be raised. The nation simply cannot pay its debts and sustain worthwhile federal programs without more revenue.
While that's a generally accepted bit of grade-school math in much of the political realm, it has become heresy in the GOP, which has taken up residence in a parallel universe of fairy godmothers, unicorns and Easter bunnies. In that universe, lowering taxes for the rich magically creates jobs, fills government coffers and spreads prosperity for all.
That's bunk, of course. George H.W. Bush famously called it "voodoo economics." Still, that notion -- proved wrong as recently as the presidency of George W. Bush -- has gained a certain power through frequent repetition.
So it fell to Obama to remind Americans of the Clinton years -- when taxes were higher, the budget was balanced, the deficit falling and prosperity widespread. The balanced federal budget was squandered by Obama's predecessor, who slashed taxes, spent recklessly and presided over a period of tepid economic growth.
Obama will need to repeat the facts that link higher taxes with increased prosperity time and again. And even he didn't go far enough; the president ought to propose raising taxes on the merely affluent, not just the rich.
Moreover, Obama has only started to nibble at health care spending in Medicare, a voracious federal program. He ought to be frank with the nation's elderly: They are draining an exorbitant amount of the national treasury, taking up resources that ought to be going to the young.
Somehow, we've managed to create an upside-down social safety net that maroons far too many children while swaddling the elderly in a cocoon. How can the nation "Win the Future" if we spend 2.5 times as much on its old as the young? (If you count federal spending alone, the ratio is more like 7-to-1.)
I don't mean to sound cavalier about the needs of the elderly, who tend to be sicker and have higher medical expenses. Obama was right to pledge to protect Medicare against the predations of U.S. Rep. Paul Ryan, R-Wis., who wants to end it.
But an adult conversation -- a TRULY adult conversation -- would engage seniors and help them to understand the consequences of our current spending curve. In nations that suffer famine, we hear wrenching stories of starving parents who give the last scraps of food to their children. We've taken a starve-the-kids, feed-the-old approach, instead.
While too many children are stuck in bad schools and poor housing, while community clinics that deliver vaccinations and asthma medicine beg for money, while young adults skip college because they can't afford it, the elderly were given a budget-busting prescription drug plan during the Bush administration. That makes little sense.
If resources are limited (and they are), the nation needs to make choices -- some more painful than others. My brother, Kevin, a Boston physician who treats kidney disease, talks about the Medicare program that pays for dialysis for anyone with failing kidneys -- including the terminally ill. Started in the 1970s to help adults still in the workforce, its fastest-growing population is now over 65, he said. And it costs tens of billions a year.
"It may not be the best use of resources for the frail and infirm elderly, and it also forces many elderly patients to spend their last days in the hospital, rather than at home," a more comfortable setting, Kevin told me.
Yet many patients, even octogenarians who don't expect to recover, find it difficult to turn down the treatment. "And physicians resist having a conversation with patients that recommends they forgo dialysis because it's an uncomfortable conversation to have. It's easier just to recommend the treatment," he said.
But those are exactly the adult conversations we ought to be having.