End Medicare
Preserving a scam in the vain hope of making it less offensive may be well-meaning, but it’s not right, and it’s not courageous.


Andrew C. McCarthy

Would you vote to save the Bernie Madoff scheme? Me neither. And when you get down to it, that’s why you can mark me down as a failure when it comes to the latest Beltway-conservative litmus test for commentary deemed worthy of adults. No, I won’t be gushing praise for the Ryan plan to save Medicare, nor reserving a seat at the coronation of its author as the most courageous, fiscally responsible Washington politician ever — or, at least, ever to vote for the prescription-drug entitlement, TARP, Keynesian “stimulus” spending, and the auto-company bailout.

Concededly, as creatures of Washington go, Rep. Paul Ryan (R., Wis.) is among the most admirable. I daresay that of all the Beltway pols who want to add trillions to the already unfathomable national debt, Mr. Ryan is among the best — his proposal is a veritable bargain at “only” $5.1 trillion more over the next decade. (And, putting aside the funny Washington math that discounts tens of trillions in unfunded liabilities, would someone please explain to me how House Republicans rationalize their admirable opposition to raising the $14.3 trillion debt ceiling with their votes in favor of the Ryan plan, which would increase the debt to over $15 trillion next year and nearly $20 trillion by 2021?)

We’re all sinners, and Congressman Ryan’s past walks on the wild side do not render hollow his earnest plea that we deal with the entitlement cancer metastasizing in our body politic. But his prescription is not a cure. It’s an aggressive treatment of symptoms that leaves the cancer in place, under the delusion that Dr. Government can be trusted to manage it.

Representative Ryan buys the foundational premise of Medicare: to wit, health care is a corporate asset — not a commodity subject to the assumptions of ordinary commerce (i.e., individual choice, controlled by one’s personal resources and priorities), but a fundamental right to which the central government must ensure access. This is the plinth of the entitlement edifice — the “second Bill of Rights” — that began construction in the New Deal, under the direction of designers who knew full well that it was financially unsustainable.

Sadly, this is the standard Beltway conservative position, too, as evidenced by the ablest of Ryan’s defenders, James Capretta of the Ethics and Public Policy Center. Writing in the May 2 issue of National Review, Jim explains, “The government plays an important oversight role in Ryan’s Medicare-reform plan, as it should.” That is to say, rest assured that we would never suggest scrapping Medicare, or that the government doesn’t have an essential supervisory role to play in the market for medical services — a role we somehow managed to do without for the first century and a half of the nation’s existence. And what is that role? Ensuring that “participating insurance companies must offer transparent pricing and meet minimum-benefit and -quality standards.”

Says who? If by “transparent pricing” Jim means insurers must be discouraged from engaging in fraud, there are already civil and criminal laws against that, and, as an additional prophylaxis, the states heavily regulate insurers. But why should the government be involved in setting standards for coverage, and what on earth does government know about quality when it comes to medical care? In a free society, those are matters for the market. At most, government’s job is to keep the market clean, not to dictate the inputs in the dreamy hope of controlling the outputs.

Medicare was a scam from the start. It had to be a scam because its ostensible purpose — providing health insurance for the elderly — was never the objective of its proponents. Instead, Medicare was a stepping stone to a utopia its champions dared not acknowledge: A compulsory universal-health-care system administered by government experts. FDR’s Committee on Economic Security initially intended to issue a health-care plan in conjunction with its universal, compulsory Social Security proposal in 1934. As Cato’s Charlotte Twight recounts, the former was dropped due to fear that pervasive opposition among the public and the medical profession would jeopardize passage of the latter. But Roosevelt got right back to it the day after he signed the 1935 Social Security Act, empowering the new Social Security Board to study the “related” area of health insurance.