[Originally posted at Doctors for America's Progress Notes Blog]
Andrew Sullivan's  tag line, via George Orwell, is that "It is a constant struggle to see  what is past the end of one's nose." One of my favorite lines is from  Upton Sinclair, "It is difficult to get a man to understand something if  his livelihood depends upon his not understanding it."
When I say "favorite," I mean I like it because it says a lot about  the human condition in general, and about our political struggles in  particular. Unfortunately, in these times, this myopia in our world  views has the potential to lead to human misery, and to continue America  on the road to tragedy, as we already have passed farce. I consider  myself an optimist, but recent events including our world class  embarrassment of a debt ceiling "deal" have left me pessimistic for our  short term prospects of reinvigorating our priorities as a nation and  consequently our intermediate term prospects of leaving the nation  better than we found it.
We have been at our best as a nation when we have had visionary  leadership, from Teddy Roosevelt's "Square Deal," to Franklin  Roosevelt's "New Deal," to LBJ's "Great Society." Even Eisenhower's more  mundane Interstate Highway System and JFK's goal to put a man on the  moon represent aspirational goals for America. ("We chose to do these  things, and the others, not because they are easy, but precisely because  they are hard!") Now, our political will has been demeaned to the  lowest common denominator: how will I keep more of my meager income for  myself in the short term?
Paul Krugman, Robert Reich,  and others have been banging this drum for over a decade now: investing  in human capital is the way to grow the economy and keep us a great  country. Many wish to continue the defunding of our societal investment  in human capital: reducing investments in education and research,  reducing money spent on the health of the population, demolishing our  social welfare programs like Medicare, Medicaid, SCHIP and Social  Security. This is short sighted and a recipe for disaster (with all the  ingredients mise en place).
We now have plugged in a small group of Congress Persons in the  wildly inappropriately named "Super Congress," with the stated goal of  resolving our budget stalemate. I am skeptical, to say the least, and  two articles in this week's New England Journal of Medicine reinforce my  pessimism.
Jonathon Oberlander points out that  "austerity politics" are now in force, and there are real potential  dangers that Medicare and Medicaid funding could be cut substantially,  including reduced payments to providers, reductions in federal funds for  state Medicaid programs, increasing cost-sharing for enrollees,  repealing the long term care insurance provisions in the ACA, and - per Paul Ryan's plan - changing Medicare into a voucher plan.
While Oberlander doesn't say it, I will: the "austerity politics"  manufactured in Washington by power brokers with lots of money behind  them are designed to take an axe to the programs that provide medical  care to those who need it and prevent expansion to those who need it  even more. We at DFA are all too aware of deficiencies in our current  health care system and are not shy at all about pointing them out. But  we also know that reforming health care requires a greater intellectual  effort than unthinking cuts born out of myopic political calculations.
In the same NEJM issue, Christopher Jennings notes that  many stakeholders in health care are coming to realize that there is  almost no good that can come out of the work of the Super Committee.  Because of the construction of the debt ceiling deal, if the Super  Committee reaches no deal and the "automatic cuts" are enacted, Medicaid  is exempt from cuts and Medicare would face "only" a two percent cut.  As he explains, it is hard to imagine a deal crafted by the twelve that  would so good to health care funding:
 From the current vantage point of these stakeholders, the choice is  therefore not a close call; the automatic cuts are by far the best  poison to be forced to take, particularly in comparison to the  concoction they fear the super committee could produce. It would meet  the requirement of the law, protect against unknown and much larger  cuts, and preserve resources and bargaining chips for the next big deal,  which will probably take place in 2013 after the presidential election.
So, there is hope, if I ditch my own myopia and hope and pray and  work for a new, better Congress in 2013, we may be able to get on the  path to becoming a great country again, instead of the "dollar store"  nation that so many seem to believe is our destiny!
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