Wednesday, 26 August 2009

Should Republicans Save Medicare?

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senior citizen in wheelchairPeople used to say politics makes strange bedfellows. These days, calling any kind of  bedfellows strange might qualify as a hate crime. It is probably safer to say that the political highway allows for frequent U-turns, as politicians discover that policies and programs they once decried as ruinous to the republic are now true and righteous.

This is nowhere more apparent than in the announcement by the Republican National Committee of a brand new "Health Care Bill of Rights for Seniors." The statement calls for legislation to protect Medicare from cuts, ensure that seniors may keep their current coverage, prohibit government from getting between seniors and their doctors, outlaw any effort to ration health care based on age, and prevent government from dictating terms of end of life care. It also calls for protection of medical benefits for veterans and their families. Of course, it has been drawn up in response to fears older Americans have about plans to overhaul the way healthcare is paid for and delivered in America.

In politics, turnabout is fair play. The Republican campaign against Medicare "cuts"  — or "savings," as Obama and congressional Democrats call them — is reminiscent of ads run less than a year ago against Republican presidential nominee John McCain, who had proposed reductions in Medicare spending as part of his healthcare reform plan. McCain said then, as Democrats are saying now, that the proposed savings would not mean any cuts in benefit levels for seniors. But the Obama campaign ran ads warning of a "22 percent cut in benefits," along with fewer services and lower quality of care.

Despite the much-ballyhooed emergence of a supposedly conservative Republican majority during the past 40 years, we have advanced rather far on the road to socialism when the "conservative" party is promising to "protect' or save Medicare. The program was opposed by Barry Goldwater, congressional Republicans, and the American Medical Association when it was passed during the glory days of Lyndon Johnson at an annual cost of a few billion dollars. In 2009, it is expected to cost $480 billion, 13 percent of the federal budget and 3.5 percent of the nation's gross domestic product. Medicare alone is now more than double the cost of the entire British system of socialized medicine.

But even at the start, the program embodied the principle of government control over provision of delivery of healthcare services, something Republicans still say they oppose. Yet their opposition to the socialized medicine the Democrats are pushing now appears more opportunistic than principled when coupled with their sanctimonious defense of Medicare. They have already accepted in the Medicare program the underlying principle of "Obamacare"-the belief that government can and should be the provider of health care for the American people. 

As New Jersey Star ledger columnist Paul Mulshine put it, America today is being treated to "the bizarre spectacle of supposedly conservative Republicans railing against socialized medicine while arguing against even the tiniest cuts in the largest system of socialized medicine on earth." Liberals have built upon the popularity and widespread acceptance of Medicare, even among conservatives, to make the case for a further expansion of government healthcare. You're against "socialized medicine"? Well, gee, is Medicare socialized medicine? 

Well, yeah, it is, even if Republicans are out on the hustings promising to protect it.  Indeed, it was a Republican Congress in 2003 that decided to subsidize private health insurers under Medicaid Advantage, which costs taxpayers an average of 13 percent more per beneficiary than the government-run program. The same Republican Congress passed the prescription drug benefit add-on to Medicare that President George W. Bush so enthusiastically championed, creating the largest expansion of the welfare state since LBJ's "Great Society."  

Yet there is no warrant in the Constitution for the federal government to assume the role of insurer or provider of health care for the American people. Nor does that role fit in any form or fashion the principles of limited government and free enterprise that Republicans and other conservatives espouse. Ironically, one of the arguments for establishing the Medicare program was that it would relieve elder Americans of the worry that they would be leaving to their children the medical bills they'd incurred near the end of their lives. This is one example of the cure being worse than the disease. Like Social Security, the whole program is based on paying the bills for previous generations. And we are now reaching a point where the retired "baby boomers" will outnumber those still working and paying into the system. According to economist Jagadeesh Gokhale of the Cato Institute, Medicare has an unfunded liability of $43 trillion over the next 75 years.

While Obama promises that his promised "reform" will reduce costs and eliminate inefficiencies in healthcare, Medicare, by Obama's own admission, stands as an embarrassing contradiction to such lofty goals. It is, in the president's own words, "going broke," "unsustainable," "running out of money." That's hardly surprising. What enterprise run by government has ever become less costly and more efficient? Amtrack? The Post Office? Education? Surely, government intervention and the cost of regulation have played a major role in driving up the cost of healthcare far beyond the rate of inflation in recent decades. And of course the increasing cost of healthcare becomes a further justification for more government intervention for the many who cannot afford it.

Those old enough to remember life before Medicare know that the old and the sick were not left in the street to die. Americans did not (in Obama's words) "pull the plug on Grandma" then, either. As Texas Congressman Ron Paul, a retired physician and former Republican presidential candidate, has said:

In the days before Medicare and Medicaid, the poor and elderly were admitted to hospitals at the same rate they are now, and received good care. Before those programs came into existence, every physician understood that he or she had a responsibility towards the less fortunate and free medical care was the norm. Hardly anyone is aware of this today, since it doesn't fit into the typical, by the script story of government rescuing us from a predatory private sector. [From The Revolution: A Manifesto by Ron Paul]

Republicans may see a short-term tactical advantage in being the born-again champions of Medicare, but they are sowing the seeds of and the nation's and their party's ruin. Conservative author and blogger Russ Douthat has described well the dangers of playing that game: "Medicare's price tag, if trends continue, will make a mockery of the idea of limited government. For conservatives, no fiscal cause is more important than curbing this exponential growth. And by fighting health care reform with tactics ripped from Democratic playbooks, and enlisting anxious seniors as foot soldiers, conservatives are setting themselves up to win the battle and lose the longer war."