Why Americans will never “grow up” as long as we have Medicare

posted at 6:30 pm on June 4, 2011 by J.E. Dyer

Beth Haynes writes at Pajamas Media today that Americans need to grow up, and stop thinking we can, in her metaphor, choose and eat cake we haven’t paid for.

Her point is good, as far as it goes.  There ain’t no such thing as a free lunch.  But as long as we have “Medicare,” we’re going to continue, willy-nilly, to behave as if we think there is one.

It is not possible to do otherwise.  When people don’t see their arrangements for medical care as a fee-for-service proposition, but rather as a collective “social insurance” scheme, in which the emotion of the moment will always be the tiebreaker for lawmakers’ decisions about other people’s money, no one has to “grow up.”

How do people “grow up” in the course of normal life?  From what does the concept of “growing up” derive?

“Growing up” means assuming responsibility for yourself.  It seems absurd to have to point out anything so basic, but then, we’ve been living under a nanny state for quite a while now.  Growing up is what you do as you transition from infant to child, from child to adolescent, and from adolescent to adult.

At each step of the way, the transition is marked by your increased ability and willingness to assume responsibility for yourself.  At a certain point, you – and you alone – are held accountable for your actions.  With that accountability comes an autonomy that almost everyone looks forward to with longing, during his or her teenage years.  You can do what you want to do about the big choices in life: what career you choose, where and how you live, whom you marry.

The price of that autonomy is taking care of your own needs.  The more responsible you are about that, the less interference there will be from others – family, the civil authorities – in your life.

Before Medicare existed, “medical care” was something you planned for as part of that responsible mode of living.  Hard as it is to believe, people paid cash for all their routine check-ups, doctor visits, and prescription drugs.  Most in the middle class maintained insurance for what was called “hospitalization,” meaning the need for expensive in-patient care, whether because of an auto or work accident, childbirth, children’s illnesses, or the health problems of the elderly.

That insurance cost far less, as a percentage of income, than today’s health program premiums.  Premiums were higher, of course, for older rate-payers and those who were especially likely to make claims, such as young couples in their child-bearing years.  For many on the payrolls of large companies, medical insurance – on the “hospitalization” insurance basis – was a benefit provided by employers.  (Naturally, your pay was lower by the amount of the monthly premium.)  Whether you paid out of pocket or your employer paid, it was smart to enroll in medical insurance early in life, as that meant your premiums – if you stayed with your insurer – would be better when you got past 50.

People were very particular about buying their insurance, because they understood that their choices about it would determine the kind of services they could claim if they needed medical care.  The concept of paying some money by the month in order to have unlimited access to medical care did not exist.  It was understood that there would be limits on what the insurance company would pay for, just as there are limits with auto and home insurance.  Saving money “for a rainy day” was targeted on the kinds of contingencies insurance might not pay for.

But middle-class Americans had much more discretion over their income then.  They didn’t fork over everything they earned in the first four months of the year to three or four levels of government.  The social contract that was based on being responsible for your own medical needs came with the particular benefit that you kept more of what you earned.

None of this meant that there was no provision for the indigent.  States and counties across America maintained publicly funded hospitals and clinics whose purpose was to provide care for those who couldn’t pay.  Religious organizations provided medical care for the indigent as well, and in some places their facilities were the first resort.  The system wasn’t perfect, by any means, but it reflected the social contract of individual responsibility combined with compassion.

When Medicare came along, it changed all that.  Literally, all of it.  Medicare divorced medical care from any understanding about prior limits on contractual obligations.  It treated medical care not as an element of individual arrangements and responsibility, but as a political issue of collective entitlement.

When experts today point out that a Medicare beneficiary draws from Medicare several times what he paid into it, they are only noting what was supposed to happen.  It was the intention of Medicare to ensure that prior contributions and prior arrangements would not limit the care retirees would receive.  Of course that’s what it does.  That was the whole point.

Beth Haynes urges us to repudiate that idea, and she is right to.  But repudiating that idea is repudiating Medicare.  If we can be brought to repudiate it, we won’t need “Medicare” at all.  Indeed, it will be a hindrance to us.  There is no point in turning something over to the government if the basis for claims on it is not to be divorced from what we put into it.  Only if it is important to us that medical care be allocated on a political basis, for political purposes, is there a reason to continue Medicare on its current model.

No one has ever argued that today’s seniors should be left to fend for themselves.  We’ve had Medicare for nearly 44 years; most who are on it today spent most of their working lives paying into it – money they could have spent differently if it had been left in their pockets.  No changes to Medicare should adversely affect their access to care.

But I think one reason it has been so easy to flog the “Mediscare” theme is that at least some people intuitively understand that the Ryan plan may be a step in the right direction, but it doesn’t break firmly enough with the fundamentally unsound basis of Medicare.  If you “grow up,” as Ms. Haynes urges Americans to, and accept that what you get out of your medical insurance has to be limited, and has to be tied to what you chose to pay into it – then what do you need a government entitlement program for?

J.E. Dyer’s articles have appeared at The Green Room, Commentary’s “contentions,Patheos, The Weekly Standard online, and her own blog, The Optimistic Conservative.

This post was promoted from GreenRoom to HotAir.com.
To see the comments on the original post, look here.


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That was weird. I got redirected to the China T-bond article the first time.

Count to 10 on June 4, 2011 at 6:36 PM

The real crime of Medicare is that we’re legally required to contribute to it, whether we want to or not, and then told that we’re not entitled to the alleged benefits for which this conscription was supposed to pay.

People feel “entitled” because if they’ve paid Medicare taxes, they feel they’re owed something (rightly so). The scam is that it’s wholly inadequate for the cost of actual care, but the government continues to demand this ransom from us anyway.

We’d all be better off if instead of Medicare we were able to put a certain percentage of our income into a personal medical ‘lock box’ – our own HSA-type account – that could be tapped at a set age (say 55) or under extraordinary health circumstances. Get this money out of the government’s hands once and for all.

They’re stealing from us and then tell us to stop crying like entitled brats.

redfoxbluestate on June 4, 2011 at 6:45 PM

Medicare and its entrenchment is exactly why the Democrats rammed Obamacare through. They know that once you get Americans to buy into such a program it will almost be impossible to convince them to give it up.

CW on June 4, 2011 at 6:45 PM

It’s not our money, it’s free. The government pays for it. What’s the problem?

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Paul-Cincy on June 4, 2011 at 6:55 PM

I reciently had an argument with someone who used the fact that health insurance premiums have been going up 15% each year to argue that turning medicare into a fixed contribution system would kill seniors because they wouldn’t be able to afford insurance after a few years. I was trying to get through to him that a) the current form of Medicare is part of what is driving those increases, and b) unless politicians are stupid with regulations, there will always be plans for exactly the contribution amount that will just have less coverage.

Count to 10 on June 4, 2011 at 7:02 PM

We’d all be better off if instead of Medicare we were able to put a certain percentage of our income into a personal medical ‘lock box’ – our own HSA-type account – that could be tapped at a set age (say 55) or under extraordinary health circumstances. Get this money out of the government’s hands once and for all.

They’re stealing from us and then tell us to stop crying like entitled brats.

redfoxbluestate on June 4, 2011 at 6:45 PM

If it was just about getting out what you put in, plus even an unreasonable interest rate, that would be one thing. The problem is that medicare sets out to pay for everything (if at a discounted rate), meaning that the industry incentives are to create something, anything, that can get “covered” by medicare.

Count to 10 on June 4, 2011 at 7:07 PM

What business does the government have in our personal lives?

Speakup on June 4, 2011 at 7:12 PM

What you are talking about is the ultimate responsibility that Americans have largely been educated out of: that somehow, with the right combination of medical science and governmental interference, we can cheat death.

I’m not advocating throwing grandma off a cliff, or euthanizing the terminally ill (unless they themselves should request it, being of lucid mind), or trying to persuade the sick and dying to give up (a disgusting tenet, by the way, of Obamacare). I’m saying we should, as we did in the past, take responsibility for ourselves and, yes, fight the consequences as long as we can, but accept them when we can’t.

RebeccaH on June 4, 2011 at 7:20 PM

Good luck changing this nation of looters and moochers into grown-ups.

Aquateen Hungerforce on June 4, 2011 at 7:23 PM

Good luck changing this nation of looters and moochers into grown-ups.

Aquateen Hungerforce on June 4, 2011 at 7:23 PM

It will happen when people are forced to do without. We’re borrowing $1.65 trillion a year, basically having such as the Chinese work for us, on the promise we’ll pay them for that work in the future (plus compounded interest).

This year our budget is $3.82 trillion, which we pay for with $2.17 trillion in revenue, and $1.65 trillion in borrowing. We’re not CLOSE to living within our means. We’re mortgaging the future big time to pay for, WHAT, today? Retirement, medical, welfare, food stamps.

It will all stop, soon, after we can’t borrow any more money. I guess what will happen is hyperinflation. $15 gas, $10 milk, $10 bread. We are so screwed.

Oh, let’s not cut Medicare. That would be a disaster. :)

Paul-Cincy on June 4, 2011 at 7:31 PM

Is it only me but the talking heads are always spouting off about how much SS & Medicare recepients get and how unfair it is, this is after you are forced to pay into your whole working life.

NOTHING is ever mentioned about the real entitlement programs like WELFARE AND MEDICAID whose recipients never contribute one thin dime.

PLUS Obamacare takes 500B(Billion)from the Medicare fund( taxpayer contributions) to GIVE to Medicaid.

Lets talk about the real entitlements WELFARE AND MEDICAID

concernedsenior on June 4, 2011 at 7:33 PM

I can remember $5 and $10 doctor’s office visits — the entire cost for a check-up or having some minor ailment looked at. Now, one is lucky if one has only a $10 or $20 “co-pay” to tend to when the doctor gets done.

Has anyone looked closely at the relationship between the sharp rise in medical expense to the individual and the entry of “government” into the overall equation? On the surface it seems that when “government” got involved the costs started going up. The more government stays involved, the costs continue to go up.

And, I remember “hospitalization” insurance as well…for the big things..for an emergency. Wasn’t really all that long ago.

My current monthly contributions to my “health insurance” add up to a good chunk of change…and the costs keep rising and the availability of treatments and specialists seems to be dwindling.

I’d blame the collapse of health care coverage in America to government involvement…you know, government taking from the “rich” to pay for those who couldn’t, wouldn’t or simply don’t care to actually contribute to their own health care costs.

coldwarrior on June 4, 2011 at 7:42 PM

I would be glad to give up MC and my supplemental policy. I could use the money to pay for private insurance that covers what I need under one policy. If you haven’t reached 65 yet, you may not know that the govt forces you onto MC and any insurance policy you had will not cover you anymore. It’s not free. We pay for MC and our private supplement. Try going to the doc without it.

Kissmygrits on June 4, 2011 at 7:56 PM

How do people “grow up” in the course of normal life? From what does the concept of “growing up” derive?
=================================================

Interesting,someone from Alaska,stated,

“Buck Up or Stay in the Truck”!!(sarc).

canopfor on June 4, 2011 at 8:19 PM

The problem with “free” health care is the same with “free” anything, supply and demand will ensure we never have enough of it. If government paid for beer, we would water our lawns with Bud and cry about how “big beer” is not meeting our needs as we create shortages.

This is why a solution such as Ryan’s is vital. We need to involve market forces by not paying the full price of health care. Consumers must provide some part of the cost in proportion to the cost of what they consume. Otherwise, people will “water their lawn” with health care and we will run out.

MJBrutus on June 4, 2011 at 8:36 PM

Just wait until the money runs out. Reality has a way of bitch-slapping stupid people.

GarandFan on June 4, 2011 at 8:46 PM

Good luck changing this nation of looters and moochers into grown-ups.

Aquateen Hungerforce on June 4, 2011 at 7:23 PM

The problem is defining who is a moocher and who is a looter I guess. As someone else said lumping Medicaid and Medicare as well as SS with welfare is purposely clouding the issue. Why do you thing they continue to do that? Even if all of the programs all in trouble confusing the issues doesn’t help people understand the problem.

whbates on June 4, 2011 at 10:10 PM

Social security as well.

MadDogF on June 4, 2011 at 10:13 PM

Medicare and its entrenchment is exactly why the Democrats rammed Obamacare through. They know that once you get Americans to buy into such a program it will almost be impossible to convince them to give it up.

CW on June 4, 2011 at 6:45 PM

Exactly-it is so much easier to give than it is to receive. It’s nearly impossible to take something away once someone deems it to be “mine”, especially if they feel they pay into it directly or indirectly.

I believe all of the New Deal programs that weren’t ousted by the Conservative Coalition or deemed unconstitutional are still around. I do like the CCC as it requires that the participants actually work, and somewhat the WPA.

The thought of working for local, state or federal government for unemployment is intriguing. But I can only imagine the waivers that would have to be signed, you’d have to have a physical, this or that couldn’t be done because you might get hurt, people would whine instead of being grateful, many would show up and do little or nothing…

Dr. ZhivBlago on June 5, 2011 at 3:12 AM

Responsibility is soooo right-wing.

WannabeAnglican on June 5, 2011 at 8:15 AM

I’m 47 years old and don’t want Medicare or Social Security. I’d like to just opt out of the “voluntary” Income Tax. That should be an option……

adamsmith on June 5, 2011 at 8:16 AM

I’m 67 and retired US Army. I don’t want medcare, can’t use it have no need for it but I must pay $3,000/year and can not op out of it.
Medicare save money??? Watch the money. You see it every day on TV, “we do the paperwork for you and garanteen you will get the ____”. they are running 100% to 5000% markups. I need an air filter for my C-pac machine. It a 1-2 in foam filter. Cost to make $.05 ea. Can only by from on line company for $6.00/ea. When asked why the markup? Answer “thats what the gorvernmen allows us to charge”.
The VA seems to handle this very nicely and dose not allow any thing like this to happen.
Why can’t the medicare and medcade even get close.

jpcpt03 on June 5, 2011 at 4:16 PM

The real crime of Medicare is that we’re legally required to contribute to it, whether we want to or not, and then told that we’re not entitled to the alleged benefits for which this conscription was supposed to pay.

And that’s my problem. I have no qualms about putting away money for retirement, but you better damn well believe that if I’m forced to pay taxes for a program that is allegedly meant to cover me down the road, I’d better collect on it.

I’m not entitled to other people’s money, but I want back every penny I paid into Medicare, Social Security.

englishqueen01 on June 5, 2011 at 5:54 PM

No one has ever argued that today’s seniors should be left to fend for themselves.

Really? I will. They didn’t “pay into it.” They were taxed and those taxes have been burnt up in a giant pep rally bonfire. Sorry, tough.

The seniors are collectively the wealthiest of all citizens. They can and should fend for themselves. If we are ever to address the issue of responsibility, we have to acknowledge that seniors are the wealthiest, the most experienced, and best trained to fend for themselves.

It’s the half-way argument that’s a loser. Here it is: We’re against socialism and welfare, except for those who already have it, oh, and for most everybody else as well.

It is not moral to enslave generations of children so that the current entrenched set of gluttons can finish their meals.

Oh, but healthcare’s too expensive? Well, let’s get to the root of that. THIRD PARTY PAYER system. That’s it. Get rid of it. Period.

Pablo Snooze on June 6, 2011 at 10:56 AM