So a left-of-center president delivered a left-of-center inaugural address–how shocking is that? Barack Obama is a winner, and he acted like one on Monday; he can be a liberal now. He is, after all, entering into a select club within a select club: assuming that all goes well for him, he will be just the 14th American president to serve two full terms in office.
But when the panegyrics have died down, Obama will confront the problem that every president re-elected since the passage of the 22nd Amendment  is also a lame-duck president. And in spite of years of negotiations in his first term alone, no one, least of all Obama, has solved the looming problem of healthcare—which is the root of our spending and entitlement troubles.
Medicare and Medicaid together cost more than $800 billion a year, and that total is rising fast. An aging population requires even more costly healthcare, no matter who pays for it. No simple compromise between the parties will make the problem go away.
On the basic issue of the size of government, conservatives still have an edge. A Fox News poll taken earlier this month found that 83 percent of Americans think that “government spending is out of control.” And that’s up from 78 percent who said so in 2010 and 62 percent in 2009. Today, a mere 11 percent of Americans think spending is being managed carefully .
To be sure, huge majorities of Americans also support entitlement programs. So Republicans and Democrats will continue to fight for the right issue-frame: for Republicans, attacks on “big government” à la Andrew Jackson; for Democrats, FDR-ish defenses of popular benefit programs.
In his Second Inaugural, the president put himself in an interesting position . “The commitments we make to each other through Medicare and Medicaid and Social Security, these things do not sap our initiative, they strengthen us,” he said, continuing, lest anyone wonder what he really thinks of Romney, “They do not make us a nation of takers; they free us to take the risks that make this country great.”
Is the president thus ruling out changes in Medicare along the lines suggested by legislators like Paul Ryan, such as “premium support”? Maybe, but in the same speech, he also said that we are going to have to make “hard choices to reduce the cost of health care and the size of our deficit.” Every “deficit hawk”—including those within the Obama administration—has a prescription for shrinking the increase. The problem is that voters don’t much like those “curve-bending” prescriptions. And neither do most Democrats.
Plenty of waste exists within the public health system, but voters tend to be suspicious of cost-saving reforms because they long ago concluded long ago that Washington, D.C. is more interested in saving money on these health programs, especially those for the elderly and the poor, than it is in improving and saving lives through better care.
And that rampant mistrust can be toxic to even the best intentioned of entitlement reformers. As the late Jack Kemp said, “They don’t care how much you know until they know how much you care.” If entitlement reformers regard healthcare programs simply as targets for savings, then the beneficiaries will naturally seek to defend themselves. That makes entitlement reform next to impossible.
So is there another way out—a way to save money that doesn’t risk ballot-box backlash?
Inside the expenses of our healthcare system is an item that dwarfs the others in magnitude. Alzheimer’s Disease currently costs the US economy some $200 billion a year, mostly in direct outlays from Medicare and Medicaid. That number is rising toward $1 trillion a year by mid-century.
While it’s easy in 2013 to reach a deal that calls for saving money on Alzheimer’s costs in decades hence, such a deal will likely be unenforceable in the far future, when the reality of 24/7 care year-round for tens of millions of dementia patients is upon us. If that many people are so sick, the U.S. will either move toward some sort of euthanasia system or else shoulder the ruinous costs. Surely there’s a better way.
And that better way could be a cure: to do to Alzheimer’s what we did to polio—make it disappear.
There’s no guarantee that an attempt to cure Alzheimer’s will succeed. But the history of focused medical research efforts—not just the March of Dimes campaign that led to the polio vaccine, but the development of antibiotics, the worldwide eradication of smallpox, and the enormous progress made against HIV/AIDS—argues strongly that significant gains are possible in a relatively short time, provided there’s enough leadership and scientific and financial effort.
Policymakers, looking ahead and seeing that “silver tsunami” of Alzheimer’s sufferers roaring toward them, should be actively strategizing about how to thwart the illness: that is, strategizing the way the Pentagon strategizes about acquiring a new airplane or ship.
The 2012 elections settled one question: national health insurance, in one form or another, is here to stay. Uncle Sam is ultimately going to be responsible for the nation’s healthcare.
But that answer has given rise to new questions: How can we make healthcare as affordable as possible without sacrificing quality—and dignity? How can we use medical research and technology to make actual improvements in people’s wellbeing, as opposed to mere maintenance? Unless we address those questions, and soon, we will never find a politically or morally satisfactory answer to the problem of rising healthcare costs.
The need to fend off such a bleak prospect ought to bring leaders of both parties back to the bargaining table, for their sake as well as ours. A cure for Alzheimer’s and other costly diseases won’t be found in D.C., but if the Beltway is oblivious to the need to help foster medical research and development, then the lifesaving cure as well as cost-savings might never be found.
James P. Pinkerton is a contributor to the Fox News Channel and a TAC contributing editor. Follow him on Twitter .