As usual Simon gets it right - the budget debate is not about money, its a mask for social policy and worldview:
The real issue is how much relatively rich people are willing to pay and on what basis in the form of transfers to relatively poor people – and how rising healthcare costs should affect those transfers.
The consensus for Hamilton, Jefferson, Madison and their contemporaries was simple: No significant social spending was administered by the federal government. Lindert estimates social spending (including on “poor relief” and public education) in the United States even by 1850 was less than 0.5 percent of GDP.
We’ve come a long way since 1792, but the question is: How far exactly? And are we willing now to debate the real issues: taxes, healthcare costs, and what kind of redistribution we think is fair and sustainable?