Oct. 19 (Bloomberg) -- President Barack Obama is betting his presidency on the success of his health-care bill. The politics of health care may now be costing troops their lives in Afghanistan.

Make no mistake. The situation in Afghanistan is spinning out of control. Yet only a few years ago, the situation in Iraq was analogous. Iraq turned around because of a new strategy and a surge in troops.

The architects of the successful Iraq strategy have devised a new approach for Afghanistan that has a solid chance of success. The window of opportunity, though, is rapidly closing. General Stanley McChrystal, the top U.S. and NATO commander in Afghanistan, described the situation as follows in the Washington Post late last month: “Failure to gain the initiative and reverse insurgent momentum in the near-term (next 12 months) -- while Afghan security capacity matures -- risks an outcome where defeating the insurgency is no longer possible.”

With the clock ticking, you would think that an assessment like that would lead a president to act quickly and decisively. You might even think that this president would be such a man. Obama said all the right things about Afghanistan during the campaign, noting repeatedly, “this is a war that we have to win.” Yet now that he has reviewed a clear strategy to accomplish that objective, the president has become indecisive, and delayed making the call week after week.

While he dithers, troops who need reinforcements are stuck in the line of fire. The death toll has spiked in the last three months. July, August, and September had 45, 51, and 37 U.S. fatalities, respectively. No previous month in the first eight years of the conflict had exceeded 28.

Get Serious

It may be that Obama wasn’t serious during the campaign when he committed to victory in Afghanistan. But, even if true, that can’t explain delay. If he wants to surrender, then he needs to order a retreat before men and women lose their lives needlessly. Indeed, he should have done so already.

But if he is serious about winning, then he should have acted already. How can he be stuck in the middle for so long with so much at stake? The answer may well be that the high stakes health-care debate has come between the troops and their reinforcements.

A surge in Afghanistan costs lots of money, and so does a health-care bill. The primary hurdle between a health-care bill and passage in the Senate is budgetary. The insistence of many senators that any expansion of government spending be paid for has gummed up the works. Just about every attempt to pay for the bill has elicited angry opposition.

Budget Hawks

Passing authorization for a large troop buildup will be easy, as it will be supported by Republicans. But passing health-care legislation after authorizing an Afghan surge may well be impossible.

Budget hawks are budget hawks because they want America to live within its means. The bigger the deficit gets, the more difficult it will be to get those hawks to look the other way while government enacts a new entitlement.

A little bit of bean counting puts the challenge in perspective.

McChrystal has requested a force of 40,000 more troops. Many observers predict that Obama would likely approve a lower number, perhaps 30,000. That figure is similar to the number included in the Iraq surge.

How much would that cost? The final supplement to the budget under former President George W. Bush included $180 billion, covering the surge in Iraq as well as an additional 30,000 soldiers in Afghanistan. Assuming the per-troop costs are similar, the surge in Afghanistan will likely cost about $100 billion annually.

Price Tag

It is difficult to say how long such an action would take, but at that price, a five-year stay for the additional battalions would cost almost $500 billion, on top of the cost of the forces already on the ground. The final cost would probably be somewhere in between those two numbers.

The surge is almost certainly worth the money. Failure in Afghanistan would allow that country once again to become a safe haven for terrorists. But the cost of success is high as well.

The sad fact is, the delay of the decision on Afghanistan makes no sense unless it is part of a politically calculated plan to delay revelation of the true costs of the war until after the health-care legislation has been passed.

Obama and his friends in Congress need to stop playing politics with the lives of our troops. Given how little room for error there is in the current budget, we should take a pause in the health-care debate and insist that the president put his strategy on the line for Afghanistan.

When Afghanistan is resolved, we can return to debating health care.

(Kevin Hassett, director of economic-policy studies at the American Enterprise Institute, is a Bloomberg News columnist. He was an adviser to Republican Senator John McCain of Arizona in the 2008 presidential election. The opinions expressed are his own.)

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To contact the writer of this column: Kevin Hassett at khassett@bloomberg.net

Last Updated: October 18, 2009 21:00 EDT