Health Care, Medicare, Caregiving, and Don’t Care

It wasn’t long before all responsible observers came to agree with ME that the NY-26 result (despite the quirky details) is one piece of evidence among many that the Republicans are losing the debate on Medicare. They’re still winning on health care (meaning Obamacare).

Here’s one reason why: One health care the Democrats have a plan for reform (that’s already law, of course). The Republicans are for its repeal. People like repeal mostly because they think Obamacare will wreck the employed-based plans they know and love to rely upon. Old people also don’t like Obamacare because it’s being paid for, apparently, by cutting Medicare.

On Medicare: The Republicans have a reform plan (Ryan’s). The Democrats are against it. People like Medicare as it now is. They don’t want the move to a “voucher.” They think they’ll pay more and get less. And being old, as a result, will become riskier than ever. They’re already more paranoid than ever (with solid evidence) that their money can’t last as long as they do.

People are conservative on these issues in exactly this way: They like what they have, and they think change will mean they’ll have less. Let’s face it: One of the facts of the welfare state’s erosion is that they’re right.

The Republicans have to convince them that the move from DEFINED BENEFITS to DEFINED CONTRIBUTION is the wave of the future. Anyone who says it can be stopped is lying. And something like Ryan’s plan offers the best deal they can get in an era of diminished resources for entitlements. That’s a tough case to make into change they can believe in.

We’re going to need to rely on VOLUNTARY CAREGIVING more than ever to meet this crisis. One piece of American exceptionalism is how much we rely on that even now. Yuval Levin sees this better, I think, than the Randians and even the Tea Partiers. But one result of our creeping and somewhat creepy libertarianism is that the infrastructure that makes such caregiving—done mainly, let’s tell the truth, by women—possible is imploding too.