Medicare is hated by conservative elites. And it was hated long before it even existed. In 1961, Ronald Reagan said, “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.” He was talking about what would become Medicare. It’s silly in a way, but also callous and hateful. Now, of course, conservative elites have a problem because the one group that consistantly votes for conservative candidates is totally dependent upon Medicare. They mostly have sunset years because of the medical care that Medicare provides. Although I will admit that many of them do spend a lot of time telling young people about how great things used to be.

The truth is that Medicare has a problem: it costs a lot. This fact is often used by conservatives to claim that Social Security is not sustainable. It’s nonsense, but fundamentally Medicare is not sustainable. But it is true that Medicare is not sustainable. This is because we pay about twice as much for the same medical care as people in other advanced countries like Canada, France, Germany, and Japan. Medical inflation seems to be slowing down. But if things don’t improve, no one will be able to afford healthcare in America. Now that’s an issue of freedom that Reagan ought to have been worried about.

But conservatives are not interested in dealing with Medicare problems reasonably. The truth is that the elderly would just be squeezed out of the private insurance market. And the one thing that would have any chance at all of stopping that would be Obamacare, which conservatives also want to destroy. There isn’t a lot of honest discussion about healthcare on the right. Conservatives just want to destroy any system that will actually cover people. And to be honest, I’m not sure why this is. It seems to be some kind of ideological gut reaction that is not based on anything rational.

Now the most “reasonable” man running for the Republican presidential nomination is Jeb Bush. And I just read in Think Progress, Jeb Bush Quietly Suggests “Phasing Out” Medicare. And it’s the same old thing: let’s keep Medicare for those who now have it but then get rid of it for those who will soon need it as much or more. Or to put it more bluntly: let’s keep Medicare for the people who currently vote Republican and screw over everyone else.

This is always phrased as something that we must do for fiscal reasons. We just can’t afford to fund Medicare! But there are two big things wrong with this. First is just that the costs are not going away. Older people will still need medical care. So the question is only and forever who is going to pay. Second is that benefits determine taxes. There is this bizarre idea that many politicians and pundits have that somehow you could get rid of Social Security benefits but just keep on collecting those payroll taxes.

Ideology trumps everything in the conservative movement. They don’t like Medicare because it is “socialized medicine.” That doesn’t mean that they actually know what socialized medicine is. (Medicare is actually socialized insurance, not socialized medicine.) It is just a conservative bogeyman. But the press really needs to do a better job of covering this stuff. Bush needs to be asked what he thinks should be done to help the elderly who won’t get Medicare. I know what Bush actually thinks: nothing. But it would at least be fun to hear him say what I know he would: buying insurance across state lines; tort reform; high deductible plans — the usual conservative answers to every healthcare problems that would, in fact, do little if anything to address the problems.

Update (24 July 2015 10:33 am)

I didn’t realize just how much Medicare spending had leveled off. This is from Paul Krugman. It shows that per patient Medicare costs in inflation adjusted dollars have stopped growing. Amazing.