TYLER COWEN, in a New York Times op-ed yesterday, was pretty pessimistic about America's chances of getting its fiscal ducks in a row.

The technocratic Keynesian recommendation was to run deficits in bad times and surpluses in good times. But except for one stretch during the Clinton administration, this notion has been broken since the early 1980s. In the United States, at least, Keynesian economics has failed to find the necessary political institutions to enact and sustain a wise version of the theory. Now that fiscal constraints are starting to bite, many politicians are afraid to reform or even to discuss changes in the largest problem areas: Medicare and Medicaid. Yes, some laudable cost controls on Medicare are embedded in the new health care law, but they're not enough. Most likely, we will end up making other spending cuts that won't solve our fiscal problems—and in areas that could instead benefit from Keynesian employment stimulus. These kinds of knee-jerk, poorly reasoned decisions are what happens when fiscal illusion reigns.

By "fiscal illusion" Mr Cowen refers to the tendency to view short-term borrowed money as more real than the long-term money with which one will have to pay it back. His solution is classically conservative, in the sense of "pessimistic about human nature", and even a bit obscurantist; he quotes an old professor who believed that "the real choice was between a religion of budget balance and a rule of illusion. Seeking an optimal technocratic path is not on the menu." I would have more instinctive affinity for this view if it didn't appear that basically every country in the world has substantial public debt, and there seems to be little relationship between debt as a percentage of GDP and wealth. In my layman's fashion, this leads me to suspect that maybe it's possible for a country, like a company, to have too little debt financing. (Which is not to deny that America's current level of debt should probably be lower, and that we have serious long-term debt problems.) Of course part of what's going on here is that richer countries borrow more because they can; investors credit their ability to repay their debts. Then again, the same holds for companies. What do I know.

But it's certainly true that the largest problem areas in the long-term budget picture, far and away, are Medicare and Medicaid. Indeed, Paul Ryan agrees, too; check out the charts he's been showing to congressional Republicans to coax them to support his budget plan. And it's absolutely true that the "knee-jerk, poorly reasoned" budget cuts Republicans are carrying out this year have nothing whatsoever to do with solving America's medical cost-inflation problem.

The Times has been running an excellent editorial series on the consequences of the Republican cuts: $235m from USDA inspectors and the FDA, more than 10% of their budgets, potentially bringing meat and poultry plants to a halt; essentially eliminating federal funding for poison control centres; zeroing out American funding for the International Panel on Climate Change. (This last goes beyond the war on science; it's just slap-in-the-face politics, pure sneering provocation at those they perceive as their enemies. I'm more used to seeing this sort of thing in the Russian Duma.) One thing that's striking is how many of the cuts not only won't reduce American health-care costs, but will clearly increase them. What do you think happens when you eliminate poison control centres? As the Times points out, emergency-room visits are considerably more expensive than phone calls.