Medicare and Masochism

Ed Kilgore writes about Medicare which reminds me that I've been meaning to point out that this is where the masochistic cult that passes for elite conventional wisdom in Washington may do real damage.

According to the High Lords of Punditry, we've got trouble right here in Capital City, with a capital "T" and that rhymes with "e" and it stands for "entitlements." The trouble with entitlements is that they're projected to grow too costly. This is a problem that needs dealing with. The primary way it needs to be dealt with is by "painful measures" -- i.e., benefit cuts.

Lately, we've been seeing this analysis of the situation primarily applied to Social Security wherein the grain of truth in the theory is so small as to be hard to detect. This is massively annoying, but ultimately, it's actually so far from the truth that I doubt it will do much harm. Democrats seem to be resisting the temptations of masochism, and rightly so. The trouble is that as applied to Medicare it isn't entirely wrong. It really is true that maintaining all of our current policy commitments with regard to Medicare will wind up boosting spending to an unwisely high level. This grain of truth is big enough that it could move people to act, but small enough that it could lead to large-scale unnecessary human suffering.

Medicare masochism is basically a manifestation of intellectual laziness combined with callousness. Medicare policy is extremely complicated. Our health care system is messed up in a large number of ways, and Medicare has many design problems that lead spending to be higher than it needs to be. But Medicare policy is not only complicated, and difficult, but deadly boring. Devising a workable proposal that would control spiraling costs in a smart way would be very hard. In fact, it would be beyond the capacity of pretty much every pundit in town. Indeed, I doubt that 85 percent of the bloviators out there could even comprehend a reasonable proposal if it was put before them. 90 percent of the remainder are simply too lazy to do it. Politicians fail to implement such reforms for a bunch of reasons, but one important reason among them is that it's genuinely hard to figure out what we should do. Rather than acknowledge any of this, however, the opinion elite prefers to simply call for "courage" and "pain." And, of course, pure willpower can cut costs easily enough by simply shifting costs onto patients. But this doesn't actually solve anything. It'll be almost as large a drag on the economy and it'll get people killed.

What's needed are actual solutions -- efforts, for example, to end the supply-driven element of Medicare spending -- that will reduce the cost of care, not simply shift that cost around. But we'll never get even close to having such solutions available until the pain caucus shuts up for a few years about the courage and starts opening up column inches for people who actually know what they're talking about to put some ideas forward.