Who Cares About Medicare?

Republican Congressman Roy Blunt draws the ire of The Washington Monthly's Steve Benen for suggesting that maybe Medicare wasn't such a good idea after all. Benen writes:

It's a reminder of how the status quo can trip up GOP leaders. The current system already has the government playing a role in making health care available to the elderly, military personnel and veterans, the poor, and low-income children. None of these developments have ushered in the collapse of capitalism or a dystopian bureaucratic nightmare for consumers. It puts Republicans in the position of having to explain why it's fine for the government to play a health care role in some contexts but not others.

I won't dispute that Medicare is popular, or that politicians — even Republicans — don't usually criticize it, but it hasn't exactly been an unqualified success. On the contrary, as the CBO reports, the program's fiscal future looks dire:

For decades, spending on the federal government's major health care programs, Medicare and Medicaid, has been growing faster than the economy (as has health care spending in the private sector). CBO projects that if current laws do not change, federal spending on Medicare and Medicaid combined will grow from almost 5 percent of GDP today to almost 10 percent by calendar year 2035 and to more than 17 percent of GDP by 2080. That projection means that in 2080, if there are no changes in policy, the federal government would be spending almost as much, as a share of the economy, on just its two major health care programs as it has spent on all of its programs and services in recent years.

Medicare might be an old and beloved program, and that might make it politically untouchable most of the time, but the program is far from a runaway success. Indeed, fixing the looming budgetary problems with Medicare is a key reason why many are keen to overhaul the current system. Suggesting that Medicare's potential problems outweigh its benefits — particularly given that the establishment of Medicare and Medicaid have made it exceedingly difficult to implement a true market-driven health-care system — might be politically ill-advised, but it doesn't actually seem all that crazy.

It's probably true that health-care reform geared toward providing universal coverage wouldn't "usher in the collapse of capitalism or a dystopian bureaucratic nightmare" for patients. But one needn't see a Roland Emmerich-style catastrophe on the horizon to worry about the potential for problems with a massive expansion of government involvement in health care, nor does one need to think of Medicare as an unmitigated disaster to think that perhaps it wasn't all that great an idea.

Last month, Shikha Dalmia wrote about problems with Medicare-style insurance; in 2003, Kerry Howley wrote about generational warfare over Medicare deficits; and in 1999, former Reason editor Virginia Postrel warned against expanding the program.