The enemy the Pentagon should fear most: health care.

• Author: Sapolsky, Harvey M.
• Position: DEFENSE BUDGET

* The U.S. military keeps searching the horizon for a peer competitor, the challenger that must be taken seriously. Is it China? What about an oil rich and resurgent Russia?

But the threat that is most likely to hobble U.S. military capabilities is not a peer competitor, rather it is health care. In the 1950s, health care was 4 percent of gross domestic product--about the same percentage that defense spending now holds. Defense back then (during the Korean War) was around 16 percent of GDP. The two lines crossed in the 1970s with health consuming an increasing share of GDP and defense a declining share. Neither the Reagan buildup nor the war on terrorism after 9/11 changed things much. Health care reached the 16 percent mark after the millennium. It is now in striking distance, absorbing 18 percent of an admittedly battered GDP.

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The defense spending squeeze is on and will become more constricted by health care reform. It is not apples and oranges. About half of the United States' health care costs appear on the federal government's budget, which directly affects revenues and expenditures. European nations plead poverty when it comes to funding their militaries in large part because of the squeeze of social spending (including health care). They spend a smaller, though rising, share of their GDPs on health than does the United States, but more of that spending is direct government expenditure.

Health reform is justified based on the need for controlling spending, and includes a promise that efficiency, regulatory, and patient incentive changes will cover the increases in costs that will come from covering more of the uninsured. For Democrats, closing the gap between the insured and uninsured and giving America a truly national health care insurance system has been a goal whose fulfillment has eluded their best efforts since the New Deal. Presidents Truman, Johnson, Carter and Clinton all tried. The late senator Ted Kennedy had made it a career quest. With the Democrats controlling the executive and legislative branches of government by large margins, the stars seemed aligned for President Obama to be the one to deliver the holiest of political promises. The outcome of the recent Senate election in Massachusetts may have derailed Obama's opportunity, but not the growing burden that health care expenditures place on government and society.

Health care cost control is an illusion. No one truly can make the health care...