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America's defining choice

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By NICHOLAS KRISTOF New York Times News Service

The Tampa Tribune

Published: November 13, 2009

President Barack Obama and Congress will soon make defining choices about health care and troops for Afghanistan.

These two choices have something in common - each has a bill of around $100 billion per year. So one question is whether we're better off spending that money blowing up things in Helmand province or building up things in America.

The total bill in Afghanistan has been running around $1 million per year per soldier deployed there. That doesn't include the long-term costs that will be incurred in coming decades - such as disability benefits, or up to $5 million to provide round-the-clock nursing care indefinitely for a single soldier who suffers brain injuries.

So if Obama dispatches another 30,000 or 40,000 troops, on top of the 68,000 already there, that would bring the total annual bill for our military presence there to perhaps $100 billion - or more. And we haven't even come to the human costs.

As for health care reforms, the 10-year cost suggests an average of $80 billion to $110 billion per year. Granted, the health care costs will continue indefinitely, while the United States cannot sustain 100,000 troops in Afghanistan for many years. On the other hand, the health care legislation pays for itself, according to the Congressional Budget Office, while the deployment in Afghanistan is unfinanced, will raise our budget deficits and undermine our long-term economic security.

So doesn't it seem odd to hear hawks say that health reform is fiscally irresponsible, while in the next breath they cheer a larger deployment of troops in Afghanistan?

Meanwhile, lack of health insurance kills about 45,000 Americans a year, according to a Harvard study released in September. Based on the numbers from the study, a person dies every 12 minutes in America as a consequence of lack of health care coverage.

As many people die every three weeks from lack of health insurance as were killed in the 9/11 attacks.

The health reform legislation in Congress is imperfect, of course. It won't do enough to hold down costs; it may restrict access even to private insurance coverage for abortion services; it won't do enough to address public health or unhealthy lifestyles.

Likewise, troop deployment plans in Afghanistan are imperfect. Some experts think more troops will help. Others think they will foster a nationalist backlash and feed the insurgency (that's my view).

So where's the best place to spend $100 billion a year? Is it on patrols in Helmand? Or is it to refurbish our health care system so that people don't die unnecessarily every 12 minutes?

Kristof is a columnist for The New York Times.

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