Martin Dyckman: Right wing should stop its nonsense about Medicare

America’s doctors have long since made their peace with Medicare, which marked its 50th anniversary last week, but its oldest and most implacable enemy, the ideological right wing, is still bent on destroying it.

If you were a politician who shared that purpose, how might you go about it?

You’d harp on how the trust fund is running out of money, with no possible solution except to deny Medicare to those who don’t already have it. You’d exempt those already on the rolls, but those who aren’t would have to settle for something less.

If that sounds familiar, it’s a rephrasing — but not by much — of what Jeb Bush said to one of the Koch Brothers’ audiences last month.

His exact words:

“We need to make sure we fulfill the commitment to people that have already received the benefits, that are receiving the benefits. But we need to figure out a way to phase out this program for others and move to a new system that allows them to have something — because they’re not going to have anything.” (Emphasis supplied.)

Medicare’s long-term solvency does need to be assured, and there are responsible suggestions for doing that.

But the scare tactic those italicized words express is grossly irresponsible. So is the strategy of splitting off the senior vote. It’s as if Bush thinks we won’t give a damn whether our children and grandchildren get what should be theirs so long as we keep what’s ours. That presumption of selfishness is personally insulting.

What does he want? Generational warfare?

Let’s get some facts straight:

  • Medicare is an insurance program into which nearly everyone pays or has paid premiums. The benefits are reserved, however, for the 46 million who are over 65, along with 9 million disabled younger people.
  • Medicare’s legal commitment is not just to “those that have already received the benefits,” but to everyone who is paying for them.
  • To the extent that Medicare is drawing down its trust fund, a younger generation is already partly subsidizing an older one. Tell them often enough that “they’re not going to have anything,” and maybe they’ll believe it.


There’s time to do better. The Hospital Insurance Trust Fund is now expected to be in the black until 2030, four years later than before Obamacare began to yield economies. Even then, income from payroll taxes would suffice to pay 86 percent of benefits, according to the Medicare Board of Trustees.

That’s 15 years to enact responsible solutions that cover the other 14 percent. Not all proposals are or will be responsible.

Bush seems to like Congressman Paul Ryan’s voucher scheme, or has said so in the past. (The official government terminology is “premium support system.”) People would buy their entire coverage in the private market, as many of us do now to supplement what Medicare pays. There would be a federal voucher pegged to regional costs of service.

The benefits to the Treasury would be relatively modest, and as, the Congressional Budget Office notes, “highly uncertain.” What’s very certain is that everyone would pay more out of pocket,

The great devils in the details are that once Medicare is no longer a single-payer system, cost control becomes the consumer’s responsibility and Congress can more easily get away with contributing less money.

Medicare is one of the most successful government programs ever. It has prolonged the lives of millions of people and saved countless numbers from bankruptcy. Its low administrative overhead puts the commercial insurance industry to shame. Its weakness is in spending too little to detect and prosecute fraud.

But Medicare’s overall success is what keeps it high on the right wing’s hit list. As Paul Krugman explained it in The New York Times last week:

“The real reason conservatives want to do away with Medicare has always been political: It’s the very idea of the government providing a universal safety net that they hate, and they hate it even more when such programs are successful. But when they make their case to the public they usually shy away from making their real case, and have even, incredibly, sometimes posed as the program’s defenders against liberals and their death panels.”

It’s the same motive that commits an entire political party to trying to destroy the Affordable Health Care Act. Every enrollment increase is bad news to the Koch Brothers and their allies.

In their libertarian outlook, any government program that helps people deprives them of liberty. I don’t doubt that some of them truly believe this, although with others it’s simple selfishness coated with snake oil.

Their remedy for everything, Krugman notes with scorn, is “the magic of privatization.” It’s magic in this sense: They’re the wizards of ooze.

• • •

Another anniversary passed with less notice last week. It was the 101st birthday of Frances Oldham Kelsey, a medical doctor and pharmacologist to whom uncountable thousands of baby boomers literally owe their lives or good health.

In 1960, during her first month of employment at the Food and Drug Administration, she resisted heavy pressure from a pharmaceutical company to allow the sale of thalidomide, which was being widely marketed in Europe as a wonder drug for insomnia, headaches and morning sickness. She questioned whether it was safe.

There was soon proof that it wasn’t. Children all over Europe began to be born with missing arms or legs, or flippers where limbs should be, or with serious internal injuries. Thalidomide’s effect on early fetal development was pernicious. As many as 20,000 children were harmed. Many died.

That it didn’t happen here was thanks to Frances Kelsey, who received a medal from President John F. Kennedy for her courage under pressure.

She lives in quiet retirement at Chevy Chase, Md. Please remember her when you next hear some politician dump on “over-regulation” by “government bureaucrats.”

Martin Dyckman is a retired associate editor of the St. Petersburg Times. He lives in Western North Carolina. Column courtesy of Context Florida. 

Martin Dyckman


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