Blocking Coalitions and the Politics of Medicare

Rosalind Helderman’s Washington Post report on how the politics of Medicare might impact a post-election effort to craft a bipartisan reform reminded me of Arnold Kling’s reflections on the risk of default, which I discussed in a late January column:

In “How a Default Might Play Out,” Kling begins with a series of noncontroversial observations, including that the current level of outstanding debt isn’t America’s real challenge. Rather, the problem is the growing imbalance between the cost of Medicare (and, to a lesser extent, Social Security) and federal revenues. The obvious solution is to restructure both programs to make them sustainable and, failing that, to increase the tax burden. In Kling’s view, however, it is very easy to assemble a blocking coalition against changes, particularly in the case of Medicare. This reflects the generic opposition of retirees, who like the program as it is, and the ideological opposition of liberals and conservatives: “Republicans tend to be ideologically opposed to top-down rationing, while Democrats tend to be ideologically opposed to bottom-up choice.”

So choice-based reforms, like that championed by Republican House Budget Committee Chairman Paul Ryan and Democratic Sen. Ron Wyden of Oregon, are opposed by the left, and top-down reforms, like those championed by President Obama, are opposed by the right. If we assume that these deeply held ideological stances aren’t going to change overnight, the only alternative to reform is a massive tax increase. And it is hard to imagine a universe in which Republicans will embrace any such tax hike.

We would thus find ourselves at an impasse until creditors forced our hand. The logic of political competition is such that neither side can give the other a free pass — in light of Democratic attacks on Republican proposals for Medicare reform, it would be very politically challenging for Republicans to embrace Democratic-backed reductions in Medicare expenditures. The Hawk-Dove game is playing out in practice before our eyes.   

Reihan Salam — Reihan Salam is executive editor of National Review and a National Review Institute policy fellow.

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