A reader writes:

You're justified in pointing out your opposition to Medicare D and the energy bill in 2003 as evidence of your longstanding fiscal conservatism. I think an honest accounting, however, would also need to justify your support of Bush's budget-busting tax cuts as well (which you were still supporting and defending at least as late as 2006). What principle justifies exploding the deficit for the purpose of giving cash to rich people but condemns it for giving prescription drugs to old people?

Well here goes, with a quick answer:

Because in 2000, we had a growing surplus and I was alarmed it could be siphoned off into more entitlement spending, and naively believed the tax cuts would prevent this. I did not realize that the Bush administration would both cut taxes and explode spending and launch two massive wars off-budget. That's why I endorsed Kerry in 2004. I still believe that prescription drugs for the retired should be means-tested, as healthcare spending has been distorted by politics to favor the affluent retired rather than the working poor.

The explosion in medical costs since 2000 or 2003, along with the brutal recession, and a greater awareness of the real suffering this has created, has also convinced me that systematic reform is necessary, as long as it is fiscally responsible. After a decade of stagnant wages, and dramatically rising inequality, this conservative, persuaded largely by Obama, has come around to favoring universal access to insurance as a core matter of re-balancing the polity for social stability and helping an increasingly beleaguered middle class, whose vibrancy I regard, following Aristotle, as a key element in social order.

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