March 29, 2005

Fear Not Of Medicare

Matthew Yglesias makes a very good point here:
Medicare policy is not only complicated, and difficult, but deadly boring. Devising a workable proposal that would control spiraling costs in a smart way would be very hard. In fact, it would be beyond the capacity of pretty much every pundit in town. Indeed, I doubt that 85 percent of the bloviators out there could even comprehend a reasonable proposal if it was put before them. 90 percent of the remainder are simply too lazy to do it.

Politicians fail to implement such reforms for a bunch of reasons, but one important reason among them is that it's genuinely hard to figure out what we should do. Rather than acknowledge any of this, however, the opinion elite prefers to simply call for "courage" and "pain."
Yes, yes, the next pundit who points out, without solutions, that politicians are too cowardly to fix Medicare ought to be strung up by his or her (well, usually his) thumbs. *Dusts off hands.* So that takes care of that. The next step, then, is even more important: Stop the op-ed gang from spilling more ink arguing that Medicare is some over-gorged monster entitlement that needs both drastic gutting and hacking into bits (just one won't do) lest it bloat out of control and suffocate the whole economy.

That's sad and, I think, misguided. If anything, Medicare should be the model of what's right with health care in America, and a basis for how to address broader health care issues (the two are connected issues, after all). And, yes, I'm serious. Consider: The program has controlled costs far better than the private sector over the past two decades. Its administrative overhead is tiny. Enrollees love it, even though they get relatively modest benefit packages. And so on. The big "criticisms" of Medicare in vogue among the Beltway—"oh no it doesn't encourage enough private competition!"—are sometimes vaguely interesting, but the best of them usually involve tweaks rather than a fundamental reworking of the system's structure. (Back in the late '90s, when pundits actually were coming up with interesting proposals for Medicare, Matt Miller wrote up a good proposal for introducing "premium support" into the program, though I think the way Medicare already employs the private sector (except for drug coverage) is the right place to start. More on that some other time.)

At any rate, the Medicare model needs a bit of polish, yes, but the basic model itself is sounder than people think. It's not broken. Of course its costs will rise over the next few decades—the country is aging, people want more health care, what does one expect?—but that's something we can certainly pay for if we so choose. A key part of the debate, then, should be over whether we do want to so choose or not.

Oh, and one other thing: A few months ago, Ted Kennedy proposed that we expand Medicare for all Americans. Like quite a few of Kennedy's ideas, this was actually a good one, but because it was Ted Kennedy, "moderate" opinion leaders assumed there was something scandalously wrong with the proposal and steered clear or recoiled in disgust. Too bad. Yale professor Jacob Hacker has put out a more modest version (pdf) of this idea, and his is very good too. But these things are never going to get discussed sensibly so long as wholesale "bashing" of Medicare (as antiquated, as out of control) remains cool.
-- Brad Plumer 3:26 AM || ||