To steal a phrase, if what I know about the federal budget was dynamite I would not know enough to blow my nose. I do know this much, however: Federal budgets cannot afford big tax breaks, expensive wars, homeland security, Medicare and Social Security, and the social safety net that hangs between America’s poor and hard pavement, when the economy is weak.

The Bush administration and the U.S. Congress are hoping that you don’t have enough cerebral dynamite to notice this about the 2004 federal budget, which now awaits the president’s approval. It includes a tax break of at least $350 billion, focused primarily on America’s wealthier taxpayers. It leaves future Medicare and Social Security needs inadequately funded, does not yet include money for the Iraq war, and will leave budget deficits of $200-plus billion every year that the economy is not cooking with gas. It puts many of our costs off to our children, bless their hearts.

Otherwise, it looks great.

Why would a doctor get his prostate in a twist over this budget, especially when it includes tax breaks for people like doctors? Because the 2004 federal budget, and its predecessor of last year, leave the American health care system and America’s social safety net in a situation analogous to some of Iraq’s hospitals in the days after the collapse of Saddam Hussein’s regime, that is helpless against financial looting by budgetary mobs of this and future years. Unless the U.S. economy turns around and starts humming more than it ever has, that economy is not going to produce the tax dollars necessary to meet all of these priorities and also avoid huge federal budget deficits. Something else will have to give, and that “something” will be health care and social programs for the poor and middle class.

When budgetary push comes to shove, defense and homeland security will not get cut, not with defense industry lobbying, al-Qaida bogeymen, and American armies in foreign lands. The Iraq war must be funded at some point, because you cannot drop bombs and then not pay for them. Tax cuts will not be cut, not when the president who proposed them is up for re-election. The interest on the federal debt and the current costs for Social Security must be paid. All of these costs have armed divisions of lobbyists and politicians, or the law, ready to protect their budgetary perimeters when budgetary looters are out looking for easy targets.

Health care and social programs, on the other hand, have no such protection. They have a few armed camps; doctors and hospitals and insurance companies are pretty tough, for example. They cannot protect those interests in the street fighting for federal dollars, however, because they lack the air cover of a social policy that guarantees Americans access to health care and other basic human needs. There is no guarantee to shelter in the world’s richest country. There is no universal health insurance, and no guaranteed package of health care benefits for every American. We cannot even guarantee that if you need some pill to keep you alive you will always be able to get it.

Worse, the leadership we have in Washington these days does not see it as its duty to stand at the walls guarding the interests of the average American patient or the poor. The big political guns stand at the walls of other forts, such as those protecting the defense budget or the interests of the American pharmaceutical industry. Would that the interests of poor, working women and middle income senior citizens were as well protected as the interests of the pharmaceutical industry, which contributed more than $30 million to the 2002 election campaigns of current members of Congress.

So health care and social programs are where the budget mobs will go looting for money when future federal budgets are in deficit, because those are big, relatively defenseless targets. In fact, the mobs have already been there this year, and but for senators like Maine’s Olympia Snowe they would have looted even more billions for tax cuts in the 2004 budget. As it was, the proposed budget cuts billions from social programs and health care. In order to fund tax breaks and other priorities, the budget mobs essentially carted off the money necessary to fund a Medicare prescription drug benefit.

Talk about shock and awe; the Bush administration has proposed that premiums for Medicare recipients increase by 12 percent next year, even while the federal Food and Drug Administration has begun to threaten the ability of those Medicare recipients to buy cheaper prescription drugs from Canadian pharmacies. Medicaid, which insures America’s poorest citizens, is being cut in virtually every state. Talk about collateral damage; in Oregon the state cut the money for prescription drugs for the mentally ill. At this rate the health care system will not be able to afford bedpans in a few years; you will just have to wait until you get home to say “Aaahhhh.”

Who will protect the American health care system and the social safety net from further financial looting in the budget years ahead? Who knows – perhaps in a few more months there will be some Marines around with nothing else to do. We sure could use a few good men and women to stand up for our huddled masses.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.