Monday, May 18, 2009

It Would Work If We Had More People

I wanted to link to this last week, but never got around to it: From Megan McArdle, Medicare is going to bankrupt us, which is why we need universal health care.

Perhaps predictibly, someone showed up in the comments to my post on Medicare and Social Security to argue that liberal analysts have very serious plans to cut Medicare's costs, which is why we need universal coverage, so that we can implement those very serious plans.

I hear this argument quite often, and it's gibberish in a prom dress. Any cost savings you want to wring out of Medicare can be wrung out of Medicare right now: the program is large and powerful enough, and costly enough, that they are worth doing without adding a single new person to the mix. Conversely, if there is some political or institutional barrier which is preventing you from controlling Medicare cost inflation, than that barrier probably is not going away merely because the program covers more people. Indeed, to the extent that seniors themselves are the people blocking change (as they often are), adding more users makes it harder, not easier, to get things done.

I suppose there's some possible argument that only with universal health care can we prevent providers and consumers from realizing there's an alternative they prefer to the status quo . . . but that implies a Canadian style system that outlaws private care, which is not what anyone's proposing, not what anyone's going to get out of the American political system if they do propose it, and not just a little bit disturbingly totalitarian.

Otherwise, people who want to reform Medicare to make it more cost effective should go ahead and propose the changes to Medicare they can get passed. I am not going to buy a pig in a poke on the slim chance that the pig might be able to get me 20% off an echocardiogram.

This is part and parcel of the same general problem I've mentioned here time and time again when it comes to discussions on health care. Supporters of universal care can point to any one issue, big or small, and use that issue as an example of why we need one massive system of health care coverage for every single person in the country. And these arguments are only made in regards to health care. No one advocates for government provided universal food coverage or universal housing in response to hunger or homelessness (usually recognizing the complexities involved), yet when it comes to health care, this notion of one giant fix-all plan pervades the national consciousness.


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