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Life Health > Long-Term Care Planning

On the Third Hand: Promises, Promises

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To me, it seems as if President Obama and Mitt Romney are pretty much on the same wavelength and that, if circumstances were (a lot) different, Obama might bring in Romney to make up for the gaps in his own lack of private-sector experience.

Romney simply knows how businesses work. Obama thinks he does but doesn’t. But, at heart, they are both logical men who just want to do what will work.

They’ve both hired campaign managers who’ve watched “The Candidate” a few too many times and have told them to pound the other guy. So they’re going around thumping their chests at each other, sounding a little too harsh because, actually, what they’re passionate about is doing well on the assignment, “Pound the other guy.” If the assignment is to attack the opponent, then they’ll attack, hard.

Today, the Democrats are attacking Romney because a leaked version of a Romney-Ryan platform apparently shows that Romney and his running mate, Paul Ryan, want to replace the current defined benefit approach to Medicare and Medicaid funding with a defined contribution approach.


Some frequent commenters believe that we should adopt an entirely, or almost entirely, pure free-market approach to government, including health care finance. I would like to see those commenters have a country where they could try their ideas out, but this country is not that country. The government here interferes so much with the money supply, the income tax system, education funding, licensing rules, real estate and building rules, and other matters that there cannot be anything resembling a free market in many important health care sectors.

So, in my opinion, at this point, we often need government intervention to try to repair the effects of earlier government intervention. I think the country owes a basic level of medical care, food and emergency shelter to all people, in part because interventions that help higher-income, more plugged-in people keep very poor people from improving their lot by building shacks on vacant lots, selling junk on the street corner, and taking many of the other steps they might take to get by in a genuinely free market system.

Maybe we should define some of the health care benefits we will as a country offer everyone. We wll provide emergency care for all. We will always treat communicable diseases. One way or another, whgether through the private insurance system or other means, we’ll make sure that people who need relatively simple, low-cost care and have a good shot at getting better will at least get the simple, low-cost care. We will provide some kind of basic custodial care for people who are dying or are very ill and can no longer take care of themselves.

And I think it’s completely fair for Democrats to say that rich people should show that they are serious about trying to get the country’s finances under control by volunteering to pay more in taxes. Demonizing the rich and imposing confiscatory taxes is wrong, but we all benefit from living in the United States and all should do what we can to improve the country’s finances.

The Gist

But, with all that said: Promising that we will provide the equivalent of today’s traditional Medicare coverage for each senior in 2035, or 2055, or 2075 does seem absurd. How does anyone know what the future will be look in those years or what resources will be available to meet benefits obligations?

Many of the problems government agencies of all kinds are facing are the burden of having to try to make good on health or retirement benefits promises made back when the times were much better than they are today.

On the other hand, opponents have published scathing analyses of Romney and Ryan heath finance proposals, and I think it’s quite possible that the critics are competely right. I have no idea whether the Romney-Ryan defined contribution health budget proposals would work. Maybe not.

On the third hand, it’s sad to see Democrats try to base a major offensive against Romney on the idea that him calling for the country to shift to more of a defined contribution approach to running Medicare and Medicaid is shocking.

Maybe the country will end up growing so much that we’ll outgrow  benefits funding problems. Otherwise, it seems as if time itself will shift us toward a defined contribution approach. If we empty out the Medicare trust fund and have to pay as we go out of current revenue, that in itself will end up being a kind of defined contribution funding system. We’ll contribute what we can as we go along.

Opponents blast Obama for breaking a health care system that was already broken. Now the Obama campaign is mocking Romney for throwing out a public health program funding methodology that was already rickety.

Sooner or later, I think we’ll all come a lot closer together on these issues, and some of us will have to eat crow.


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