The mass pledge by health care providers today to reduce $2 trillion of spending reflects some cold political calculations by hospitals, doctors and other key players about President Obama's to reshape the U.S. medical system.

Chief among these is that Obama is likely to prevail in his efforts to expand access to public insurance and allow the government to negotiate Medicare outpatient prescription drug prices.

In speeches and policy pronouncements, Obama has successfully twinned an overhaul of the health system with the broader economic recovery. And with fortified Democratic majorities in both houses, the administration is working hard with Senate Finance Chairman Max Baucus, D-Mont., and other allies to move legislation in the next two months.

As a presidential candidate, Barack Obama fairly ridiculed his Republican opponent John McCain's crusade over congressional earmarks, saying the targeted spending only accounted for about $18 billion of the federal budget.

How then to explain the scene on Thursday, where President Obama proudly portrayed $17 billion worth of program terminations and reductions in his fiscal 2010 budget plan as a substantive step toward fiscal sanity?

"We can no longer afford to spend as if deficits don't matter and waste is not our problem," Obama declared. "We can no longer afford to leave the hard choices for the next budget, the next administration -- or the next generation."

President Obama’s budget hit list is out today, and it includes a notable leftover from the Bush administration’s hit list: Even Start, a family literacy program created by a former Republican chairman of the House education committee.

Like the Bush administration before it, the Obama administration says it’s time to get rid of the Even Start program, currently budgeted at $66 million a year, because it doesn’t work. “The most recent evaluation found no difference between families in the program and those not in it across 38 of 41 outcomes,” Office of Management and Budget chairman Peter Orszag notes in a blog post on the White House Web site.

It certainly doesn’t sound promising. Here’s the catch, though: According to the administration’s Terminations, Reductions and Savings volume, the “most recent evaluation” was done in 2003.