CBO Director on the Long-Term Budget Proble...

Peter Orszag, the director of the Congressional Budget Office, has an op-ed on the long-term fiscal situation in the Wall Street Journal today -- it's today's must-read budget article, although unfortunately it's behind the Journal's subscription wall. (Rupert Murdoch hasn't had a chance to change that yet). But since the CBO is expected to put out its new round of long-term projections tomorrow, you'll probably hear similar themes then. Basically, Orszag argues that health care costs are driving the long-term fiscal problem -- after all, there's a reason why Medicare is by far the biggest chunk of the long-term fiscal exposure, and why it's going to hit us sooner.

But this is another situation where public engagement is truly crucial -- public opinion is far behind the budget experts on this issue, and they really haven't started grappling with the alternatives, either on Medicare specifically or health care in general. Just to quote from Public Agenda's "It's Time to Pay the Bills" report:

This research, and other work conducted by Public Agenda over the years, suggests that health care is especially difficult to understand. Some problems are easy for people to grasp and others – although they may be equally or more important – are abstract and difficult. Some issues engage people’s attention even though they do not have a full understanding of their impact. Others fail to capture the public’s interest, even when clearly compelling facts about their urgency and importance have been placed on the table.

Americans certainly know that health-care costs are high. In fact, many initially named it as a top issue. They understand that having more people live longer and survive into their frail later years, is enormously costly. But people talked about this issue less often and less cogently than about retirement. It may be that Americans have a better understanding of Social Security because it has received extensive news coverage.

Despite the public’s vague understanding of the huge role that health care plays in U.S. fiscal problems – and the desire most have for more government protection, not less – people were able to begin to talk about possible reforms. In the ChoiceDialogues, where people received more information, and talked about specific ideas for holding down costs, most participants were open to a range of proposals.

So don't let anyone tell you the public can't weigh real alternatives and make clear choices on this -- but someone's got to give them a chance to do it.

By the way, Orszag has started blogging, too, and that will be worth watching.