Not Entitled
Ending Medicare does not mean abandoning the elderly.


Andrew C. McCarthy

One is tempted to dismiss Pete as a most eccentric Burkean. After all, he remains staunchly pro-life, even though Roe v. Wade has been woven into the American fabric almost as long as Medicare. He is an enthusiastic supporter of the Bush freedom agenda, which elevates liberty over order and stability. The idea that our betters have the inside track on virtue, and will let us know which battles are worth fighting and which call for Burkean restraint, is closer to the disposition of the modern Left than to anything that might deserve to be called conservatism. But I prefer to think Pete has simply missed the Burkean points relevant to a discussion of Medicare. It is not the destructive political program that has been woven into our fabric, but the notion that a decent society, even one that cherishes individual liberty, is not indifferent to those who cannot fend for themselves.

Burke, I’d wager, would have construed Medicare as a perversion of that notion. Unlike Medicare, Burke’s concept of society included a genuine sacred inter-generational trust, an inheritance that enriched a people, bonding them through the ages. Medicare, by contrast, is gluttony run amok, the impoverishment of future generations by our insatiable contemporaries.

Furthermore, as I demonstrated in the column, Medicare was never intended by its proponents to be health insurance for the elderly. It was a stepping stone to — oh, let’s let Ronald Reagan explain:

The legislative chips are down. In the next few months Americans will decide whether or not this nation wants socialized medicine . . . first for its older citizens, soon for all its citizens. The pivotal point in the campaign is a bill currently before Congress. The [bill] . . . is a proposal to finance medical care for all persons on Social Security over 65, regardless of financial need, through the Social Security tax mechanism. Proponents admit the bill is a “foot in the door” for socialized medicine. Its eventual effect: across-the-board government medicine for everyone.

Reagan’s diagnosis of the Medicare activists’ ulterior motives was given under the auspices of a 1961 campaign that succeeded in turning back the tide, at least for four years. History has proved him a prophet. It would not have surprised Burke, who, in the course of arguing that “the power of bad men is no indifferent thing,” counseled that we should never “separate . . . the merits of any political question from the men who are concerned in it,” since “designing men never separate their plans from their interests.” Burke warned that if, instead of fighting such men, “you assist them in their schemes, you will find the pretended good in the end thrown aside and perverted.” You will have helped them accomplish not the good you intended but their unsavory objective.

The left-wing social engineering to which the Ryan plan surrenders is not compassion for the elderly. It is the entitlement construct. The foundation of Medicare, and of the Second Bill of Rights that was the goal of New Deal socialism, is that citizens, as a matter of right, have a claim on the property of other citizens, which government is obliged to enforce by confiscation. Once you cede that premise, the game is lost, no matter how many fleeting victories you manage to win along the way.

A welfare program to help the truly needy is something a decent society can and should support in accordance with its means, but it is not a right. The federal government need not micromanage such a welfare program; it would best be left to the ingenuity of the states, private insurers, charities, and families. A well-conceived welfare program would encourage personal responsibility rather than dependency — you want people moving out of it rather than being recruited into it. A federal entitlement is something that is owed regardless of the country’s financial condition. The central government must enforce it by coercing participation. And, because enough is never enough for those who see themselves as entitled to take, government officials are incentivized to ply beneficiaries with more and more goodies, further punishing thrift and personal responsibility.

I admire Paul Ryan’s determination to put America’s fiscal house in order. I am, however, convinced that he cannot succeed if he accepts the premises that make Medicare a monstrosity: that it should continue as a universal entitlement overseen by the federal government. Correcting that error doesn’t just mean ending Medicare, which is going to happen anyway, it means replacing the destructive assumptions of the Second Bill of Rights with the American spirit of the original Bill of Rights — replacing faith in government with faith in the abiding decency of the most charitable people on earth. If the political climate makes it too risky for elected officials to take that position, it’s up to the commentariat to change the climate. Otherwise, the demagogues win.

 Andrew C. McCarthy, a senior fellow at the National Review Institute, is the author, most recently, of The Grand Jihad: How Islam and the Left Sabotage America.