Entitlements Again?

Entitlements, most prominently social Security, Medicare and Medicaid, are receiving much of the blame for the size our deficit. Social Security is getting a bum rap. It is in surplus and is calculated to remain so till 2037. More significant, its trust fund owns around a quarter of the national debt. If a federally managed program can accumulate enough money in nearly eighty years to become one of our government’s major creditors, it must have been doing something right.  It’s misleading, often knowingly, to mention it in the same context as the others.

Medicaid is simply a charity for which the tab picked up by a combination of federal and state government. Our choice here is simple. We can either ignore the needy, causing them to lead to shorter lives or spend money to help them live longer. 

 

But Medicare is an indispensable part of our social network that, until recently, has worked well since its inception in 1965. The problem now is that the cost of medical coverage has increased at a faster rate than almost everything, in particular the money financing it. A simple solution, to which the right wing is trying to lead us, is to cut benefits, the equivalent of raising the price. Vouchers would be given to cover limited expenses.

The other approach is to take a critical look at the disproportionally increased cost of medical care. I believe price fixing is present in all components of the medical complex; doctors, pharmaceutical companies, hospitals and the insurance companies. I don’t begrudge doctors in this respect. I’d be suspicious of one known as being “cheaper.” It’s overpricing by the entire complex that’s being rationalized by the well known fact that many services are free to those who can’t pay for them. A recent charge for a friend’s hour in a hospital bed after a colonoscopy was $2,000. Even If we allow as much as half the cost of the hospital’s services going to deadbeats, a thousand would still be a gross overcharge. 

Annual limits in the voucher plan, put forward by Paul Ryan and approved by the House of Representatives, are antithetical to the concept of insurance.  I don’t carry collision insurance on my car because I can survive its entire loss. But few people would choose to do without coverage for liability. We may dislike medical deductibles, but nothing like we would a ceiling on coverage. The very insecurity that Medicare was created to prevent would be imposed on older Americans for the first time.  

Those with less than legitimate interests, who oppose reducing the cost of medical care and its coverage, enjoy an enormous financial advantage that has been greatly enhanced by Citizens United. The Ryan/Republican plan is admittedly simpler. But if we choose it over the alternative it will be too late for a very long time.