We could have a theoretical discussion of why social insurance should be trimmed way back and while we tried to convince people, the entitlement tsunami would drown us all. The best we can hope for is to avoid catastrophe through something like the Ryan plan.

I think the Social Security system is doing grave damage to America but this idea is not in political play for the foreseeable future.

On the one hand we could attempt to attack the problem via the cost levels. Of course, getting the 23 million Americans currently not employed would be a plus. If it comes between funding retirees and a 25 year old, I think most would chose the retiree. On the other hand, I don’t think most people could eye an unemployed 35 year old plumber with cancer, and say “you’re on your own.”

What will most certainly transpire, even with Health Exchanges and all that, is rationing.Of course, it won’t be called that. But, somewhere a bureaucrat will make the cost-benefit analysis. Do we pay $75,000 for granny’s hip replacement? Or do we cover the $150,000 treatment costs for a the unemployed plumber, who if he survives, can still generate another 30 years of tax revenues?

Here is the truth nobody is willing to tell (it seems to me).

Medical costs both in Medicaid an Medicare are rising rapidly. As you point out, the ratio of those paying into Medicare is too small to support the medical bills of people collecting Medicare. And of course the people receiving Medicaid are poor, so basically the same workers supporting Medicare are also supporting Medicaid.

In spite of what many people may think, as insurance goes, Medicare and Medicaid are reasonably efficient. As costs continue to increase, giving Medicare recipients vouchers to buy their own insurance—if the vouchers are expected to cover the same thing Medicare covers—cannot be expected to save money. (In my opinion, expecting costs to drop because of increased competition is pretty much a fantasy. Even if they drop some, can they really drop enough to make a significant difference?)

So if payroll taxes on workers are too burdensome to keep supporting Medicare, and vouchers for those on Medicare to buy their own insurance would be just as expensive as Medicare, it means that one way or the other, Medicare recipients are going to have to give up significant benefits and either pay for what they lose themselves, or do without.

So Democrats who are offering no plans at the moment are avoiding talking about an awful truth, and Republicans who are claiming they will “save Medicare” are not telling the awful truth that “saving” Medicare means significantly cutting benefits to the point where only the wealthy will be able to afford to buy additional coverage and not be underinsured.

Medical costs are going up so fast that, if things continue as they are, a great many people will not be able to afford medical coverage if the problem is approached collectively (with government taking a very active role) or individually (with vouchers and the like).

The American health care system is simply way too expensive, and for the average person, even currently, it isn’t very good. Other countries get far more for considerably less.

@DavidNichol,

And niether is it mine. When one looks at the the Three Big Entitlements, and their relative costs, it is Medicaid and not Medicare that is rising the fastest. But, in future years both will race eachother to the top. Our entitlements have been engineered for a nation that can provide an ever growing, large pool of young, educated, high earners. We have the opposite. There is just not enough tax revenue available to all of the public funded good works.

For this nation to afford our entitlements, we would need to have national birthrates of around 3.5-4.5 children per female.Currently our birthrate varies between 1.7 and 2.0 children per female.From 1970-1990 it averaged between 1.5 and 1.8 . We can have a society that practices “good stewardship” as far as family size is concerned. We can have a society that supports a generous social safet net. But we cannot do both.

What was the alternative to invading Afghanistan when the Taliban government refused to hand over Bin Laden and his Al Qaeda cohorts and shut down their training camps? Should we have gone to the U.N. and passed a resolution condemning the Afghan government?

Additionally, the notion propagated by Steve M that a group of “neo-cons” “highjacked” American foreign policy is conspiratorial fiction, frequently accompanied by an anti-semitic undertone. Bush, Cheney, Rumsfeld and Powell were not neo-cons. Nor were Hillary Clinton, Joe Biden, Harry Reid, John Kerry, John Edwards, and the other 20+ Democrats who voted to invade Iraq.

They believed, along with U.N. inspectors and most of the world’s intelligence agencies that Saddam possessed WMDs. Saddam was hardly a force for peace and stability in the Middle East, having invaded Iran, Kuwait, and used poison gas on his own people and defied countless U.N. resolutions. In the context of the immediate post-9/11 world, toppling that rogue regime was hardly an example of America’s “aggressive militarism abroad.”

publius,

Well, that certainly wouldn’t be Iraq. And while I think Afghanistan could not have gone unpunished for harboring al-Qaeda, has invading Afghanistan and fighting the longest war in American history there been the appropriate response to the 9/11 attacks?

Were Bush, Powell, Cheney, and Rumsfeld, part of some neo-con cabal? Or were they “highjacked” by some mysterious clique? And speaking of “highjacking” — you mention America’s alleged “aggressive militarism abroad” — are you referring to attacks against those who killed 3,000 of your fellow citizens?

I have no quarrel with the assertion that the debt has skyrocketed under Obama. We could argue until the cows come home as to whether it was foolish or wise to run huge deficits the past few years, but that is a different issue than the one I am raising. I am simply pointing out that the numbers show deficits began to balloon with the presidency of Ronald Reagan, continued under Bush 41, declined under Clinton, and shot up again under Bush 43. We can all read the numbers from objective, nonpartisan sources, and the numbers say that the last three Republican presidents, who have all claimed to be for smaller government, have added dramatically to the federal deficit. The presidency of Ronald Reagan reversed a trend of almost 35 years of falling debt and sent it soaring again. It’s just a fact.

Deal?