Welcome Aboard the “S.S. Apparent”
Well, Captain Obvious of the S.S. Apparent has nosed his ship to port again. Permission to come aboard, sir?
In today’s I-just-can’t-believe-it jaw-dropper, Captain Klein tells us that “better Medicaid coordination would cut costs.” I know what you are thinking, but it is true! Ironically, doing things better saves money. (Yes, I just used the term “ironically” ironically. How meta.)
But there are a couple of totally unwarranted assumptions at play here, and although I know Captain Klein would never deign to comment on the blog of a mere commoner, I shall rhetorically ask him a few questions all the same.
1) If all it takes to cut costs is “better coordination,” why have we not done this yet?
Is it because, perhaps, better coordination is not quite as easy as you make it seem? Is it because, perhaps, good coordination is an impossible dream in a bureaucracy of such galactic proportions? Is it because, perhaps, people in control of a top-down bureaucracy of any sort will be terminally unable to provide optimized solutions? In fact, the only way to take Klein seriously here is to have a willful lack of awareness of the problems associated with the “pretense of knowledge.” (If you’re actually going to read that, you might as well supplement it with this.)
2) What makes you think that cost cutting is the goal?
Sure, there’s some mention of “if you had to cut Medicare…” and a sop to “deficit hawks,” but let’s be real here. The ultimate goal of Medicare and any social entitlement is absolutely not delivering products and services to the widest number of people at the most cost-effective rate, is it? We already have a mechanism for that, and it’s called the market. In actuality, Medicare is about taking from some, giving to another, and reaping the political rewards. Medicare is self-perpetuating, self-inflating, and ultimately self-destructive because it is – at the very core of its existence – a political program. It will never be anything more.
3) Why should we “save” Medicare?
Because this would seem a ridiculous question to Klein, who knows nothing beyond the tiny intellectual box he lives in, I’ll concede a few points for the sake of the question. I’ll concede that seniors “deserve” medical care. I’ll concede that the “government” should provide it to them. And I’ll concede that payment should come from people other than those receiving care.
Even with all that conceded, I challenge anyone to come up with a cogent argument for saving the system as we know it. In the face of massive debt, massive deficits, unfunded promises, a stultifying regulatory regime, and a demographic time bomb of heretofore unimagined proportions, why should this relic from the baby boom be something that we seriously consider a viable solution now? It is undeniable that Medicare could be run better if we fundamentally destroyed it and built it back up. Why spend so much valuable time, effort, and money futzing around at the margins? That’s about as dumb as an Ezra Klein column.