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06 June 2011

Ending Medicare, (or Mending It)

This article from Andrew McCarthy is delightful in principle, but I think that I disagree. Here's why.

First off, I'd *love* to end Medicare. McCarthy is absolutely right on that. It's expensive and provides awful service in spite of that fact. And comparing it to a Ponzi scheme is harsh, but not terribly inaccurate. So I suppose my disagreement is more with style than with substance, or maybe more along the lines of what the German Greens talk about when they discuss the "Fundis" and the "Realos" (the fundamentalists and the realists). I think philosophically I'm a Fundi. Frankly, I really don't see a constitutional role for the government here anyway, much less when it's ridiculously wasteful and ineffective. In this respect, the overall irresponsibility of the political class on this is scandalous.

But I think McCarthy misses something when he points out that "'Incremental change,' said Medicare scholar Martha Derthick, 'has less potential for generating conflict than change that involves innovation in principle'" yet he fails to apply that to our side. It's undoubtedly true that if Republicans were to slash Medicare drastically, there would be a great deal of disruption in the health care market. If allowed to work for a couple years, these adjustments, I believe, would eventually even themselves out, and there are certainly things that a more robust plan could do to wean recipients off Medicare and insert them into alternatives. The thing is that they would never be allowed to "work for a couple years" -- Republicans would be absolutely hammered at the polls in subsequent elections, and anything that Democrats would replace it with would resort to the same salami-slicing that got us to this point in the first place. McCarthy's right that it's not courageous, but a few steps in the right direction might at least buy us some time and pave the way for further reforms. Politics sometimes has to be about the art of the possible, and what might be helpful would be someone on the Right offering a truly innovative plan to show just how conservative (insofar as that means "not radical") the Ryan Plan is. The Good Cop-Bad Cap routine is an old standby in politics; it seems like a terrific opportunity to use it here.

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