Medicare, Medicare, Medicare

I basically agree with David Brooks about this:

The foreign aid people, the scientific research people, the education people, the antipoverty people and many others have to form a humane alliance. They have to go on offense. They have to embrace plans to slow the growth of Medicare, to reform Social Security and to reform the tax code to foster growth and produce more revenue.

But, again, this basically all comes down to Medicare. It’s true, obviously, that at the margin the money is fungible. But the rate of growth in Medicare is much larger than the rate of growth in Social Security, and the growth of Social Security has a modest and projected endpoint whereas the projected rate of growth in Medicare is unbounded. Last, Medicare and Social Security both provided benefits to the same group of people — the elderly. Social Security gives elderly people money, money that can be exchange for health care services. Medicare simply gives elderly people health care services, services that cannot be exchanged for money.

This is one reason that some of us, though not David Brooks, liked the Affordable Care Act. I’m happy to acknowledge that the steps ACA takes to restrain the growth in Medicare spending are modest. But “modest” is better than nothing. Some of us have also noted that Republican ACA opponents had a marked tendency to complain that ACA did too much to restrain the growth of Medicare. And of course if you repeal a bill that acts modestly to restrain the growth in Medicare spending, you increase the growth rate of Medicare spending. So some of us wonder why folks are sitting around complaining to liberals that we’re not enthusiastic enough about cutting Social Security spending instead of complaining to conservatives about their efforts to undermine the only legislative vehicle to restrain Medicare spending that’s on the table. We need a “humane alliance” to preserve those parts of the Affordable Care Act and, indeed, to expand and accelerate them.