Not Entitled
Ending Medicare does not mean abandoning the elderly.


Andrew C. McCarthy

My modest goal in writing the column was to begin defanging the demagogues by deconstructing the revered core of their otherwise untenable defense of Medicare — namely, that it is a sacred inter-generational trust fund, opposition to which is emblematic of hostility to the elderly. This was easy to do, and not because I am either a rocket scientist or, as Pete portrays me, self-indulgently posing as a “brave dissident” from the orthodoxy he represents. It was easy to do because Medicare is going to end whether or not we call for its demise. You can’t have an inter-generational trust fund that isn’t a trust fund and has no possibility of paying what it owes.

Medicare is already broke. It is unsustainable not just in the future but right now. No less a mainstream-media pillar than USA Today concedes that Medicare added a staggering $1.8 trillion in unfunded liabilities last year alone — a little-discussed debt mountain that actually outstrips by $300 billion the annual deficit that has animated Ryan, provoked a debt-ceiling controversy, and outraged three-quarters of Americans. Moreover, as the newspaper elaborates, to portray Medicare’s future unfunded liabilities as “only” $24.8 trillion requires a suspension of disbelief, taking at face value such Obamacare bookkeeping pretenses as the 30 percent reduction of physicians’ payments — “savings” that aren’t going to be realized. As the Heritage Foundation’s Bob Moffitt recounts, the Medicare actuary, using more realistic projections, puts the accrued shortfall at $34.8 trillion — which is two-and-a-half times the annual GDP of the United States and works out to about $300,000 owed by every household in the country. (And that’s before we even think about Social Security.)

Medicare is already over. It could not conceivably hope to operate in the future as Medicare. No serious commentator on the right, even one of those mainstream enough for Pete’s tastes, argues for keeping Medicare. We are down to the charade of ending Medicare “as we know it,” and quibbling over what that should look like. No matter what happens, it will never be Medicare again. It is frivolous to portray me as an extremist for contending that we should end, rather than preserve, something that will undeniably end precisely because it cannot be preserved. Two and two is four.

The real question is not whether to keep Medicare but what it will be replaced by. On this point, Pete thinks his grating holier-than-thou mode is served by rehearsing the 1980 debate in which, countering President Carter’s Medicare demagoguery, candidate Reagan famously replied, “There you go again.” It’s ironic, because Pete is doing to me what Carter was doing to Reagan.

What I argued for was ending Medicare itself: the mendacious, unworkable, inter-generational heist that masquerades as a health-insurance program. I did not argue for abandoning the elderly who are truly needy. More than once, I argued that we could construct a welfare program to help those Americans — a detail Pete conveniently omits in his haste to paint me as a fringe character. What I said we should repeal is Medicare, the political program — not decency.

At issue is not the belief that a good society makes provisions for those who cannot provide for themselves. It is the government-ordained corporatization of a commodity best left to individual choice in a fair market — a market government safeguards without orchestrating its movements. At issue is the perverse transfer of wealth from working families (including unborn generations of working families) to seniors who, by and large, are in better financial condition to make their own private insurance arrangements. Also at issue is the fraudulently induced transfer of taxpayer dollars to both wasteful government spending and medical insiders who win space at the trough not because they provide the best care but because they retain the best lobbyists and contribute to the right politicians.

Pete is so enchanted by his well-intentioned vision of Medicare that he cannot address the reality of Medicare. The Left has spent decades equating the word “Medicare” with the concept of compassion for the aged, and thus opposition to Medicare with hostility to the elderly. On Pete, that stratagem has worked like a charm. Thus his bizarre resort to Edmund Burke, of all people, for the proposition that a one-way ticket to inevitable national insolvency is so “woven into the fabric of the American sensibility and American society” that to argue for Medicare’s dissolution is a betrayal of “an important conservative disposition.”

In this, Pete adopts the theory Sam Tanenhaus espoused in The Death of Conservatism (a theory ably refuted by Jim Piereson in the September 2009 edition of The New Criterion). For Tanenhaus, fidelity to the Burkean reverence for order and stability requires conservatives to accept progressive “reforms,” regardless of how wrongheaded they may be, once they become part of the status quo. To do otherwise is to engage in radical revanchism, a very unconservative temperament.


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