"A chicken in every pot and a car in every garage."

This was Herbert Hoover’s campaign promise when he ran for president in 1928. He claimed that every American would be prosperous under a Hoover presidency. In the spirit of the Declaration of Independence, in 1931, James T. Adams added that "life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement, regardless of social class or circumstances of birth."

In preparation for his presidential bid, Barack Obama pursued this vein and wrote "The Audacity of Hope: Thoughts on Reclaiming the American Dream." In his State of the Union speech this week, Obama invoked the "Sputnik moment" in an attempt to fan the flames of the American capacity for imagination, innovation, competition and triumph. He proposed that we build momentum with investment in research, education, technology and infrastructure.

The challenge is that additional capital expenditures today, despite substantial, potential return on investment later, will affect our budget now. According to the Congressional Budget Office, the projected deficit for 2011 stands at $1.5 trillion, and the government will need to borrow 40 cents for every dollar it spends.

The president will trim expenses and freeze annual domestic spending for the next five years. The problem is that this will result, on average, in only $80 million of savings per year. Far more is needed.

The harsh reality is that too many of us are still running on American Dream 1.0, but this version of the dream is no longer supported.

Health care reform was motivated by a moral imperative for access and passed with a promise that it will reduce overall costs. Despite savings from increased efficiencies, there is no way that increased access to tens of millions of Americans will reduce costs. Health care reform is here to stay, but reimbursement to hospitals, doctors and available services will be driven down. It is no surprise then that, this week, the president spoke of the need to reduce the costs for Medicare, the single biggest line item in the federal budget.

Much of America is still in disconnect. Voters want unfettered access to high-quality health care but still expect their elected representatives to reduce the budget. We will not be able to maintain our two largest budget items, Medicare and Social Security, minimize taxes and magically balance the budget by freezing government, domestic spending and stimulating the economy to increase the tax base.

Our third-largest budget item is the military. We can no longer afford to serve as the global policeman. We don’t have the resources or the relationships. British Prime Minister Tony Blair raised the specter of force in Iran. What about Pakistan, which is at risk of becoming a failed state? What about North Korea? Will it be easier to work with Kim Jong Un than his father, Kim Jong Il, if the young man weathers the transition to power?

The American Dream 2.0 requires awareness that our fiscal and military resources are not limitless and that our moral authority has been called into question. As the world population grows, natural resources become depleted and the temperature rises. The destiny of the American dream is becoming inexorably linked to global challenges. As a country we have no choice but to seek global solutions in partnership.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.