Defining the problem correctly

Eduardo Porter, in the NYT, offers a largely correct explanation of the Medicare problem. Unfortunately, he outlines a discussion we aren't having, and apparently cannot have.

First, clearing away a bit of underbrush, he clarifies that the reductions in Medicare spending under the Affordable Care Act are not, repeat not, cuts in benefits, contrary to the endlessly repeated and unpunished lies of WM Romney and Paul Ryan. And yes, Romney and Ryan do propose to cut Medicare benefits, while Obama does not. I won't go into those specifics yet again -- the Times has another article today, in the A section, that covers the policy issues (and quotes my old friend John McDonough).

Porter wins a Kewpie doll, however, for daring to use the word "rationing." In a world of finite resources, everything is rationed, one way or another. Unless, of course, you are Mitt Romney, in which case it would be a major problem to try to spend all your money. For the rest of us, we do without some things we might like because we can't afford them.

Why should health care be any different? Well, it can't be. Now, we could decide that we are going to continue with Medicare as it is, and not try to rein in the cost. And we could do that, for the foreseeable future, but we would have to raise taxes on the middle class, even after we got done raising taxes big time on the wealthy. (The wealthy have a lot of money, but there aren't a lot of them, you see.) At least we would if we wanted to keep spending as much on the military as we do now. But we aren't going to have that debate either.

And even if we did have that debate, we'd end up wasting a lot of money.

The way Ryan and his sidekick Romney want to limit Medicare spending is by making old people pay more out of pocket. If you don't have the money, you don't get the insurance, or at best you get cheap insurance that doesn't pay for what you need. That's rationing. By ability to pay.

Somehow that's supposed to be better than having experts and consumer advocates sit down and figure out the best way to spend a limited budget fairly and efficiently, so that everybody gets covered, everybody gets the same benefits, but we don't pay for stuff that doesn't work or costs an exorbitant amount for a tiny benefit.

Uh oh, it's that last piece that's toxic. But sorry, in a sane world -- in a libertarian world, in fact -- you don't have a claim of a million dollars on the public treasury for a shot at buying yourself two more weeks of a miserable existence. If you have a million dollars of your own, and that's how you want to spend it, go for it. But the commonwealth has to draw the line somewhere. Tell me why that's not so.