Entitlement Reform 101: Medicare, Health Care, and Caregiving

These are some very elementary observations:


It wasn’t long before all responsible observers came to agree with ME that the NY-26 result (despite the quirky details) is one piece of evidence among many that the Republicans are losing the debate on Medicare. They’re still winning on health care (meaning Obamacare).

Here are the reasons for each party's advantage.

On health care: The Democrats have a plan for reform (that’s already law, of course). The Republicans are for its repeal. People like repeal mostly because they think Obamacare will wreck the employed-based plans they know and love to rely upon. Old people also don’t like Obamacare because it’s being paid for, apparently, by cutting Medicare.

On Medicare: The Republicans have a reform plan (Ryan’s). The Democrats are against it. People like Medicare as it now is. They don’t want the move to a “voucher.” They think they’ll pay more and get less. And being old, as a result, will become riskier than ever. They’re already more paranoid than ever (with solid evidence) that their money can’t last as long as they do.

People are conservative, in both cases, in exactly this way: They like what they have, and they think change will mean they’ll have less. Let’s face it: One of the facts of the welfare state’s erosion is that they’re right.  (I've talked before about the demographic crisis, the rising cost of health care, and all that.)

The best spin that can be put on the middle American's likely future is:  The good news is you'll have more choice.  The bad is that risk is being transferred from government and your employer to you, and you'll have to pay more out-of-pocket to get the care you enjoy now through your employer. 

The Republicans have to convince middle Americans that the move from DEFINED BENEFITS to DEFINED CONTRIBUTION is the wave of the future. Anyone who says it can be stopped is lying. And something like Ryan’s plan offers the best deal they can get in an era of diminished resources for entitlements. It'll be tough to convince Americans that this tough vision is change they can believe in.  I actually think Ryan deserves credit for boldly trying to change our thinking in a genuinely realistic way, even if he's clearly for going too far too fast. 

Now THE TEA PARTIERS and their theorists are all excited about the coming new birth of freedom and a return to the Constitution of our Founders.  But their passion--as admirable as it might be--is not going to end up animating a majority of our voters.  As William Voegeli wrote in Never Enough, if people come to believe that the welfare state is unconstitutional, that'll be at the expense of the popularity of the Constitution, not the welfare state. 

We’re going to need to rely on VOLUNTARY CAREGIVING more than ever to meet this crisis. One piece of American exceptionalism is how much we rely on that even now. Yuval Levin sees this better, I think, than the Randians and even the Tea Partiers. But one result of our creeping individualism is that the infrastructure that makes such caregiving–done mainly, let’s tell the truth, by women–possible is imploding too.  Maybe the new birth of freedom or personal choice we're probably stuck with we'll lead to a renewal of voluntary associations based on personal love or charity.  Or maybe not.  EMPATHY, I've said before, is a pitiful substitute for CHARITY (or some similar virtue rooted in personal love) as the foundation for devoting oneself to others, to family, friends, the unfortunate (the disabled, the poor, and the lonely), and the common good.

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