Politics & Policy

Not Entitled

Ending Medicare does not mean abandoning the elderly.

There he goes again.

Peter Wehner, that is. He is trawling again for right-wing “extremists” (I am now a recidivist offender) from his perch at Compassionate Conservative Headquarters, where GOP solipsists are determined not to be outbid by the Left when it comes to using your money to advertise their virtue — which is how you end up burdening an already tapped-out Medicare program with a prescription-drug entitlement that is underfunded by more than $5 trillion. From CCHQ, we learn that, when you really think about it, George W. Bush was way more conservative than that Reagan guy. In fact, when you really, really think about it, President Reagan was actually a non-ideological pragmatist who sagely came to terms with the New Deal and the Great Society — and those who say otherwise are Birchers, or birthers, or some other benighted genus of the species Right-Wing Nut Job that we’d just as soon keep down in the basement, at least until we need them on Election Day.

#ad#Pete is exercised this time over my column from last weekend. In it, I argued that Medicare is a scam that ought to be ended, not preserved. Naturally, Pete doesn’t quarrel with my fact-based demonstration that, from the very start, Medicare was fraudulent: an unaffordable, unsustainable pyramid scheme whose proponents sought not medical insurance for the elderly but fully socialized health care managed by government bureaucrats. My sin, instead, is to engage in what Wehner takes to be a tactically disastrous dissent from Rep. Paul Ryan’s plan to preserve Medicare through admirably ambitious changes in its structure. If “widely embraced,” my position would, Pete decrees, “reduce conservatism to a fringe movement.” Better, evidently, to proceed straightaway to national bankruptcy.

It is hard to decide where to begin with this critique. It gets wrong both the great and the small things, while misrepresenting the gravamen of my argument and misunderstanding my role as a commentator. To take the last part first: I am not a tactician. My role is not to devise a winning electoral strategy for Republicans, one that enables them to appear unthreatening to moderates while steering the ship ever so gently in the right direction — you know, maybe “bend the cost curve” so our great grandchildren can start living within their meager means a few decades after we’ve gone to our repose having spent all their money.

The commentator’s role, at least as I see it, is to try to figure out the correct answer to the big vexing problems of the day. Insofar as it is possible, this ought to be done irrespective of the politics. With its hold on the media and academe, the Left is disproportionately influential in shaping our politics; thus, if you allow your deliberations to be cabined by politics — that box we’re all supposed to be thinking outside of, until we actually do so — you’ll never get to the right answer. If two plus two is four, it may be fine for Pete to say, “Let’s go with six, because moderate voters really want it to be six,  and the Left, after all, says it is ten, so six is reasonable.” From my perspective, it is preferable to go with four and then try to convince people that it is four, even if that means Pete will say I’m a Cro-Magnon. To make policy based on any assumption other than four will lead us to ten and to ruin.

It is not lost on me that politics is the art of the possible or that governance necessarily entails compromise. If I were a member of Congress or one of those “political strategists” you can’t swing a dead cat in a cable news green room without hitting, I would support the Ryan plan. It has serious flaws — I bet that, precisely because he is among the few adults in the room, even Ryan thinks so. But it is a big step in the right direction. As Pete says, and I concur, it is “substantively impressive.”

The problem with tacticians is that they conflate art with destiny, seeing the “possible” as the endgame, not a way station to something better. Wehner thus fails to grasp the import of one of his Reagan stories, in which the Gipper, having been chastised by his hard-charging young Office of Management and Budget director David Stockman for being insufficiently radical, grouses about self-destructive “true-believers on the Republican right.” Reagan’s point was not that the right wing ought to get with it, accept the entitlement mentality, and enact some boondoggle such as Bush’s prescription-drug plan. It was that they needed to “take half a loaf” if half a loaf was all you could get, and — here’s the critical part — “come back for more.”

Pace Pete, I don’t think it helps to tell Ryan how wonderful he is. We want him to succeed, and that means getting him to address the flaw that will prevent his coming back for more — that will, in fact, doom whatever temporary reforms he succeeds in enacting. For all the good that he does, Ryan is trapped in the politics box, and Republicans are paralyzed by Democratic demagoguery, because they have accepted the premise that Medicare is a sacrosanct entitlement. It is shortsighted to reinforce the paralysis by telling the pols they need to heed the demagoguery.

#page#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.

#ad#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.

#page#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.

#ad#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.

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