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Contentions

Another Reply to Andrew McCarthy on Medicare Reform

Andy McCarthy has written a response to a piece I wrote taking issue with his criticism of Representative Paul Ryan’s budget, including its Medicare reforms.

McCarthy’s portrait of me is somewhat amusing. In no particular order, I’m described as a grating holier-than-thou solipsist, trawling for right-wing extremists, enraptured by the Great Society, sitting at my perch at Compassionate Conservative Headquarters, an eccentric Burkean busily accusing my interlocutor of being Cro-Magnon. But since no man should be the judge and jury in his own trial, I’ll leave it to discerning readers to judge the two of us when it comes to the Grating & Eccentricity Meter. I’ll focus instead on our substantive disagreements, which represent different currents of thought within conservatism.

1. To the degree that McCarthy’s original column was notable, it wasn’t because he was expressing concerns about the current state or the conceptual flaws of Medicare, which are commonplace among conservatives. No, it was McCarthy’s criticisms of the Ryan plan and its defenders that stood out and were meant to stand out. The plan, we were told, is “not right.” It’s “not courageous.” It’s a “surrender to left-wing social engineering.” And it “leaves the cancer in place.”

In fact, the Ryan plan is the most thorough-going reform of Medicare since its inception. It goes far beyond what anyone else, including Ronald Reagan, ever proposed. If enacted it would profoundly alter and dramatically improve Medicare. It would undo or significantly mitigate almost all of the concerns most conservatives have for the current Medicare program. But for McCarthy, very little of this matters. While admitting that he would vote for it if he were a Member of Congress, for McCarthy the Path to Prosperity is fundamentally a capitulation, delusional, an abject surrender to liberalism. At this moment, he insists, the rallying cry for conservatives should be, “Medicare deserves to be destroyed.”

There’s one problem: if conservative lawmakers were to embrace McCarthy’s position — and fortunately none will — it would do massive damage to the conservative cause.

2. McCarthy posits two rather stark choices: either one agrees with him to destroy Medicare or one favors proceeding “straightaway to national bankruptcy” and “heeding to demagoguery.” If you are with McCarthy, you believe two plus two is four; if not, you believe two plus two equals six. There is McCarthy’s position, there is sell-out, and there is very little in between. But in fact there is plenty in between, including a system that features (among other things) a defined contribution plan, competition among private insurers, and means testing.

3. McCarthy devotes much of his column to complaining that I’m a defender of the Medicare status quo, which he deems to be an irresponsible position. He insists that I am “so enchanted by [my] well-intentioned vision of Medicare that [I] cannot address the reality of Medicare.” There’s one small problem with McCarthy’s argument: his premise is demonstrably false.

I’m not only a critic of the Medicare status quo and favor entitlement reform, I’ve stated my case more frequently than has, to name just one person, Andy McCarthy (see here; here; here: here; here; and here)

Not only do I support the Ryan reform; I was part of a group who months ago met with members of the House leadership to discuss it. A few of us urged them to embrace it when they were thinking of jettisoning Medicare reform altogether. Those of us who advocated tackling Medicare were by no means sure it was the politically wise thing to do. The concern was that we were advocating a position that was substantively correct but politically vulnerable. In the end, though, we believed the fiscal crisis was so serious and the dangers posed by the current Medicare system were so acute that the only responsible position was to embrace Medicare reform.

4. In my initial response to McCarthy I pointed out that when Ronald Reagan ran for president, he assured the public that he was not going to what McCarthy recommends: destroy Medicare. And when he was president, Reagan not only didn’t try to end Medicare; he did nothing to reform it. I don’t blame Reagan for that, by the way. He wisely expended his political capital in other areas, in order to achieve attainable goals (tax cuts, rolling back regulations, increasing defense spending, et cetera). Dismantling Medicare was not remotely within reach, not then and not now. Yet McCarthy would have us believe that his position (destroying Medicare) is Reaganesque. Any fair reading of the Reagan record and the Reagan approach to governing shows this isn’t the case.

5. In my first response to McCarthy I said I would put forward the conservative case for a limited, responsible role for government in the care of the aged.

Medicare does two things that need to be separately evaluated. On the one hand it has a tax-and-spending function that can rightly be criticized by conservatives and which desperately needs to be reformed.

On the other hand, Medicare creates a secure mechanism through which seniors can get coverage for premiums that don’t vary by health risk. As people age, the percentage of them with high risks rises sharply. It therefore would be nearly impossible to imagine a scenario where seniors would get affordable coverage without some mechanism that pools the risks of those 65-year-old-and-above. That is what Medicare does. It spreads the risks in a way that prevents seniors from facing either hugely expensive premiums and/or the denial of coverage. This necessary function can be combined with a vibrant market reforms that minimizes the distortions of taxes and spending. The proper conservative approach to Medicare, then, is to use market mechanisms to subsidize premiums instead of relying on a single-payer system.

6. McCarthy sees as his job advocating for the replacement of the “destructive assumptions of the Second Bill of Rights with the American spirit of the original Bill of Rights — replacing faith in government with faith in the abiding decency of the most charitable people on earth.” He adds that “if the political climate makes it too risky for elected officials to take that position, it’s up to the commentariat to change the climate. Otherwise, the demagogues win.”

There is something to be said for McCarthy’s impulse. We do need to anchor our policy debates in first principles, and challenging conventional wisdom certainly has its place. But the danger is that (a) political principles can become detached from political reality and political calculations and (b) lawmakers who must govern in the real world, amidst powerful currents and cross-currents, will be mocked as creatures of Washington, unprincipled, and lacking courage.

In all of this I’m reminded of the words of Whittaker Chambers:

[I]f the Republican Party cannot get some grip of the actual world we live in and from it generalize and actively promote a program that means something to the masses of people-why somebody else will. Then there will be nothing to argue. The voters will simply vote Republicans into singularity. The Republican Party will become like one of those dark little shops which apparently never sell anything. If, for any reason, you go in, you find at the back an old man, fingering for his own pleasure some oddments of cloth. Nobody wants to buy them, which is fine because the old man is not really interested in selling. He just likes to hold and to feel. . .


My objection to McCarthy is that his counsel would lead the conservative movement to become like Chambers’s old man, fingering for his own pleasure some oddments of cloth.

I’ve made my case; Andy has made his. I’m delighted to let others debate the merits of both.



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