Monday, February 23, 2009

Fiscal responsibility need not encroach on "earned entitlements"


So, did all of us retirees holler before we were hurt? Ezra Klein, of the American Prospect, thinks so. Today, Feb. 23, 2009, a “White House Fiscal Summit” is supposed to accompany a luncheon, and Klein points out the “entitlement reform” is not on the agenda, in marked contrast to Washington Post and other media stories right before the inauguration (around Jan. 16) saying that the president would stop “kicking the can down the road” and would sacrifice Social Security and Medicare to help profligate homeowners and Wall Street. (The White House didn't invite any amateur bloggers to the lunchoen.) You can check Klein’s parody of Dr. Strangelove here with the article “How Entitlement Reform Became Health Reform: “Why progressives should stop worrying and learn to love today's White House Fiscal Summit” with link here.

The another editor of the Prospect weighs in with an op-ed on p A19 of today’s Washington Post, “The Deficit Hawks’ Attack on Our Entitlements”, link here. Kuttner points out that Social Security is almost self-financed and in balance, and he believes that Medicare can be brought in line by automated records and compensating physicians according to results. He also suggest integrating Medicare reform to universal health insurance so that the entire system is fairer and more efficient (presumably like Canada’s).

He attacks the idea that spending on the elderly is hurting the working middle class. He says that the middle class hurts because we don’t invest enough in their own health care and education and, particularly, child care. The last item is important because some families make the deliberate decision not to have children because doing so is so expensive (sort of the “reverse baby boon problem”). But it seems as though there has been a real demographic change. We are much better at keeping people alive (through the way we practice geriatric medicine, almost by accident) than at keeping them independent and working and able to contribute, and at the same time we haven’t looked at family responsibility and structure “in reverse” enough to realize the downstream effects of the way we practice and pay for medicine for the elderly. We could, in my perspective, be building another bubble, leading to divisive social confrontation about generational responsibility outside of having children.

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