New estimates the Congressional Budget Office released Tuesday underscore that Medicare must change, a lot. More Democrats must embrace this. But Republicans also must accept that they do not have a monopoly on ideas about how to fix the program.
In this year's long-term budget outlook, Congress' nonpartisan budget analysts project that spending on major federal health-care programs would nearly double over the next 25 years under current policies, from 5.4 percent of gross domestic product to 10.4 percent. Along with a death spiral of ever-higher interest payments, that would push the federal debt to nearly 200 percent by 2037.
Hordes of retiring baby boomers would take their toll on the Treasury, but the big budget-killer would be rapid inflation of health-care costs, an expense that has outpaced economic growth by an average of 1.6 percentage points every year since the mid-1980s. In other words, unless Congress enacts massive tax increases, the government must change how it delivers health care.
The best solution would probably draw from both sides.
The Republican instinct to give patients more "skin in the game" could result in savings. So could finding a way for Congress to set aside a certain amount of the budget, and no more, for federal health programs. Democrats too quickly dismiss such things as a betrayal of senior citizens.
Yet the Republicans' approach doesn't have a clear mechanism for controlling costs. So the president's plan to raise federal tax receipts and to empower an independent body of experts to evaluate what really works could be indispensable.
It is the allergy to compromise - seen on both sides, but virtually a requirement for membership in the Republican Party these days - that is the biggest obstacle to fixing America's finances. Democrats must continue their evolution toward accepting the fact that Medicare must really change, which means less "ending Medicare" rhetoric. Republicans must make a commensurate effort to set aside their ideological preoccupations, accepting that the federal government might have to raise taxes or make hard choices about when certain procedures aren't cost-effective. As the CBO's latest numbers demonstrate, the stakes are too high for anything else.