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A Reply to Andrew McCarthy on Medicare Reform

Andy McCarthy criticizes James Capretta, my colleague at the Ethics and Public Policy Center, for writing that “The government plays an important oversight role in Ryan’s Medicare-reform plan, as it should.” This is, according to McCarthy, the “standard Beltway conservative position.”

McCarthy then lays out his case for why the Republican Party should dedicate itself to ending Medicare altogether. “Preserving a scam in the vain hope of making it less offensive may be well-meaning, but it’s not right, and it’s not courageous.” McCarthy also criticizes Representative Paul Ryan for buying into the “foundational premise of Medicare” and adds, “This is the plinth of the entitlement edifice—the ‘second Bill of Rights’—that began construction in the New Deal, under the direction of designers who knew full well that it was financially unsustainable.” McCarthy’s argument, then, applies not simply to Medicare (which was passed into law in 1965) but also, as his article makes clear, to the entire New Deal.

In a later post I’ll put forward the conservative case for why there is a limited, responsible role for government in the care for the aged. For now, I want to make several points about the prudence of McCarthy’s counsel, beginning with excerpts of an exchange between Jimmy Carter and Ronald Reagan that took place in their October 28, 1980 debate. It includes Reagan’s now-legendary “There you go again” rejoinder to Carter. But what few recall is the context of Reagan’s comments, which was to make it clear that he was not in favor of doing away with Medicare.

MR. CARTER: In the past, the relationship between Social Security and Medicare has been very important to providing some modicum of aid for senior citizens in the retention of health benefits. Governor Reagan, as a matter of fact, began his political career campaigning around this nation against Medicare. Now, we have an opportunity to move toward national health insurance. . . . These are the kinds of elements of a national health insurance, important to the American people. Governor Reagan, again, typically is against such a proposal.

MR. SMITH: Governor?

MR. REAGAN: There you go again. When I opposed Medicare, there was another piece of legislation meeting the same problem before the Congress. I happened to favor the other piece of legislation and thought that it would be better for the senior citizens and provide better care than the one that was finally passed. I was not opposing the principle of providing care for them. [emphasis added]

As Lou Cannon reminds us in The Role of a Lifetime, Reagan barely touched Medicare in his 1981 budget cuts, let alone sought to eliminate the program. Cannon points out that David Stockman, Reagan’s first OMB director, concluded that Reagan “was an insufficiently ideological ‘consensus politician’ who lacked the stomach for a serious assault on the New Deal.” Stockman said of Reagan, “He had a sense of ultimate values and a feel for long-term direction, but he had no blueprint for radical governance. He had no concrete program to dislocate and traumatize the here-and-now of American society.”

Sound familiar?

Reagan in turn complained to aides that (according to Cannon) “true believers on the Republican right . . . preferred to ‘go off the cliff with all flags flying’ rather than take half a loaf and come back for more.”

Fast forward to 2011. According to McCarthy, “Representative Ryan’s plan is a surrender to left-wing social engineering on terms the right wing naïvely believes it can accept.” One can only imagine what scorching rhetoric McCarthy would have directed against Reagan at the time, since Ryan’s plan goes far beyond anything Reagan ever attempted. Yet for McCarthy what Ryan proposes is a complete sell-out.

In truth, Ryan’s plan is substantively impressive. Even if it were not, why Republicans should embrace a position that has no chance of becoming law and would cause them to be wiped out electorally is not clear to me. The Ryan reforms may themselves exceed what the nation is willing to accept; to insist that Republican lawmakers are cowards for not trying to undo Medicare root and branch is unfair and unwise. It doesn’t take a political mastermind to imagine what would happen to the Republican nominee for president (or for that matter dog catcher) campaigning on the McCarthy formulation, “Medicare deserves to be destroyed.”

Beyond that is an important conservative disposition that McCarthy fails to take into account. Peter Berkowitz has warned against targeting for evisceration programs that are “woven into the fabric of the American sensibility and American society. The utopian dream of cutting government down to 18th-century size,” he goes on, “can only derail conservatism’s core and continuing mission of slowing and containing government’s growth, keeping it within reasonable boundaries, and where possible reducing its reach.”

What is needed by conservatives is a Burkean sensibility, a cast of mind that prefers realistic reforms to radical and jarring changes. “A disposition to preserve and an ability to improve” was how Burke defined statesmanship in Reflections on the Revolution in France. “Everything else is vulgar in the conception, perilous in the execution.” Conservatives could do worse than to take Burke’s advice to heart.

The Ryan plan, or modified versions of it, is the best that can be hoped for right now, and would, if put into effect, bring about massive improvements over the current system. It’s fine for commentators to make whatever arguments they want; they are even entitled to set themselves apart as brave dissidents from the “latest Beltway-conservative litmus test for commentary deemed worthy of adults.” But this much needs to be said as well: the mentality that characterizes the Ryan plan as a “surrender to left-wing social engineering” is one that would, if it were widely embraced, reduce conservatism to a fringe movement. Fortunately the GOP and conservatism are not terribly enamored with the idea of committing political suicide and removing whatever checks exist on contemporary liberalism.



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