The U.S. could reduce both public and private health care costs if it emulated all other developed nations, including free-market, small-government Switzerland with its private health care system, and used government-imposed fee schedules to regulate the prices charged by monopolistic and oligopolistic drug companies and  hospitals and the physician cartel.  By means of “all payer regulation,” which treats the medical industry as a price-regulated public utility, other developed countries avert American-style medical profiteering and provide comparable levels of health care to larger percentages of their populations at much lower cost, without sacrificing quality.

With respect to retirement, the focus of intelligent fiscal reform should be not on cutting Social Security benefits, on which most Americans depend in old age, but on cutting tax-favored private retirement accounts, like 401k’s and IRA’s, most of the benefits of which go to the upper middle class and the rich.  Rather than support reductions in the already meager average Social Security benefit ($1294 a month or a near-poverty income of about $15,000 a year in 2014), those who are sincerely and not just rhetorically concerned about the federal budget should demand an end to the use of the tax code to subsidize the retirement lifestyles of well-to-do investors, managers and professionals.

Cutting wasteful retirement subsidies for America’s economic elite could be achieved by, among other reforms, lowering the absurdly-high annual contribution limits to tax-deferred 401k’s.  In 2015, for a worker over 50, the annual contribution limit from all sources (employer and employee) is $59,000.  This, in a nation in which the median weekly earnings total in the fourth quarter of 2014 was $796 or around $41,000 a year, meaning half of Americans make less.  Ending favorable tax treatment for the private retirement savings hoards of the fortunate few would increase federal tax revenues which could be used for national defense, among other purposes.

Those who want more guns and less butter are confused.  The only coherent positions are held by libertarians—fewer guns and less butter, at the cost of America’s status as a great power—and by progressives and big-government conservatives—both guns and butter as the basis of America’s status as a great power.  President Ronald Reagan, who temporarily boosted defense spending to win the Cold War, even as he refused to cut Social Security and Medicare and called for the complete federalization of Medicaid, understood this reality, even if some of his putative disciples do not.

Michael Lind is a contributing editor of The National Interest and an ASU New America Future of War fellow.