The hottest issue in politics these days seems to be Medicare, notwithstanding polling showing voters care more about jobs and the economy.
Medicare was what the recent special election in New York's 26th congressional district was fought over. The government health program for the elderly has also emerged as an issue in the Republican presidential primary, with Newt Gingrich making news by criticizing Congressman Paul Ryan's Medicare plan as too radical, and with the press then scrambling to saddle the other Republican presidential contenders with Mr. Ryan's plan. And Republicans won control of the House of Representatives in 2010 in part by criticizing Medicare cuts and Medicare tax increases in ObamaCare.
As Greg Ip wrote for the Economist, "any serious attempt to reform Medicare is going to be unpopular because it will cost the elderly something, and the elderly are on the way to becoming 30% of the voting population."
For all the political heat, though, the differences between Republicans and Democrats on Medicare can look a lot like what Freud calls the narcissism of small differences.
Both parties, after all, buy the general proposition that getting control over Medicare costs of an aging population is a key aspect of the overall federal budget. The Democrats want to do it via the expert panel established by ObamaCare; the Republicans want to do it by changing Medicare down the road to a program that offers insurance premium supports rather than fee-for-service reimbursements to health-care providers. The Democrats would cut spending (or, more accurately, reduce the growth rate) via a top-down approach, while the Republican plan would rely on consumer pressure.
What all the plans have in common is the claim that the current system is unsustainable without either tax increases or benefit cuts. Joe Nocera, writing in the New York Times, said, "Even if Ryan's solution is wrongheaded, he's right that Medicare is headed for trouble. It might not be in nine years, but as health care costs continue to rise uncontrollably, and as baby boomers continue to age, Medicare will gobble up an ever larger percentage of the federal budget."
A Times editorial critical of Mr. Ryan's plan complained that RyanCare's "premium subsidy would grow much more slowly than health care costs, leaving beneficiaries stuck with an ever increasing portion of the bill or forced to accept skimpier coverage."
But the choice between "skimpier coverage" imposed by an ObamaCare death panel or a RyanCare premium support is a false one, as is the one David Brooks poses in his latest column about reining in Medicare via the Democratic central planning approach or the Republican decentralized market approach. The politicians are trapped trying to figure out how to take health care away from seniors — or payments away from health care providers — only because they haven't questioned the assumption about the demographics of the American population.
Mr. Ip's observation about the elderly being "on the way to becoming 30% of the voting population" is not inevitable. It's just a forecast. If America somehow created a new group of younger working taxpayers, the demographics would change, and with them both the political dynamics and the funding base for Medicare and Social Security.
The main problem, in other words, needn't be figuring out how to spend less on health care for seniors, but figuring out how to have more non-seniors. The way out of the Medicare fight lies in welcoming more legal immigrants to America and creating policies that make it easier for the Americans already here to have more children.
And when those young ones are ready to retire, maybe they'll be able to explain to the next generation of politicians who try to cut their benefits that there's an alternative, growth-oriented solution.
