the latest column from Dr. Krugman - please follow link to original.
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Medicare turns 50 this week, and it has been a very good half-century. Before the program went into effect, Ronald Reagan warned that it would destroy American freedom; it didn’t, as far as anyone can tell. What it did do was provide a huge improvement in financial security for seniors and their families, and in many cases it has literally been a lifesaver as well.
But the right has never abandoned its dream of killing the program. So it’s really no surprise that Jeb Bush recently declared
that while he wants to let those already on Medicare keep their
benefits, “We need to figure out a way to phase out this program for
others.”
What
is somewhat surprising, however, is the argument he chose to use, which
might have sounded plausible five years ago, but now looks completely
out of touch. In this, as in other spheres, Mr. Bush often seems like a
Rip Van Winkle who slept through everything that has happened since he
left the governor’s office — after all, he’s still boasting about
Florida’s housing-bubble boom.
Actually,
before I get to Mr. Bush’s argument, I guess I need to acknowledge that
a Bush spokesman claims that the candidate wasn’t actually calling for
an end to Medicare, he was just talking about things like raising the age
of eligibility. There are two things to say about this claim. First,
it’s clearly false: in context, Mr. Bush was obviously talking about
converting Medicare into a voucher system, along the lines proposed by
Paul Ryan.
And
second, while raising the Medicare age has long been a favorite idea of
Washington’s Very Serious People, a couple of years ago the
Congressional Budget Office did a careful study
and discovered that it would hardly save any money. That is, at this
point raising the Medicare age is a zombie idea, which should have been
killed by analysis and evidence, but is still out there eating some
people’s brains.
But then, Mr. Bush’s real argument, as opposed to his campaign’s lame attempt at a rewrite, is just a bigger zombie.
The
real reason conservatives want to do away with Medicare has always been
political: It’s the very idea of the government providing a universal
safety net that they hate, and they hate it even more when such programs
are successful. But when they make their case to the public they
usually shy away from making their real case, and have even, incredibly,
sometimes posed as the program’s defenders against liberals and their
death panels.
What
Medicare’s would-be killers usually argue, instead, is that the program
as we know it is unaffordable — that we must destroy the system in
order to save it, that, as Mr. Bush put it, we must “move to a new
system that allows [seniors] to have something — because they’re not
going to have anything.” And the new system they usually advocate is, as
I said, vouchers that can be applied to the purchase of private
insurance.
The
underlying premise here is that Medicare as we know it is incapable of
controlling costs, that only the only way to keep health care affordable
going forward is to rely on the magic of privatization.
Now,
this was always a dubious claim. It’s true that for most of Medicare’s
history its spending has grown faster than the economy as a whole — but
this is true of health spending in general. In fact, Medicare costs per beneficiary
have consistently grown more slowly than private insurance premiums,
suggesting that Medicare is, if anything, better than private insurers
at cost control. Furthermore, other wealthy countries with
government-provided health insurance spend much less than we do, again
suggesting that Medicare-type programs can indeed control costs.
Still,
conservatives scoffed at the cost-control measures included in the
Affordable Care Act, insisting that nothing short of privatization would
work.
And then a funny thing happened: the act’s passage was immediately followed by an unprecedented pause in Medicare cost growth. Indeed, Medicare spending keeps coming in ever further below expectations, to an extent that has revolutionized our views about the sustainability of the program and of government spending as a whole.
Right
now is, in other words, a very odd time to be going on about the
impossibility of preserving Medicare, a program whose finances will be
strained by an aging population but no longer look disastrous. One can
only guess that Mr. Bush is unaware of all this, that he’s living inside
the conservative information bubble, whose impervious shield blocks all
positive news about health reform.
Meanwhile,
what the rest of us need to know is that Medicare at 50 still looks
very good. It needs to keep working on costs, it will need some
additional resources, but it looks eminently sustainable. The only real
threat it faces is that of attack by right-wing zombies.
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