Health Care Conversation Winds Down

Programs exclusively for poor people tend to be poor (because they lack powerful political constituencies)...

Now, conservatives typically respond to this explanation by asking why I have faith in government to take care of everybody's health care if it can't even take care of some people's health care. My answer is that they do it, and do it well, abroad.

But the elderly are a powerful political constituency here. I still don't understand why one would think that a universal health care system wouldn't end up like Medicare here, and be just as expensive as our regular system, paying for extras tests and technology.

Also, Medicare, which serves the politically powerful elderly, and the Medicaid program exclusively for the poor aren't all that different in nature and what they cover, despite his bold statements. The VA is qualitatively different (having a reduced formulary of drugs and other things), though.

Its true that programs for the poor lack powerful constituencies, but I see this as a feature not a bug. The programs exist because the public has a sense of compassion, but it is not an unlimited sense of compassion. We expect those we help to show a minimal level of responsibility. The result is programs for the poor that are compassionate, but automatically cost controlled. If Social Security and Medicare were programs for the poor, they would not be the budget busters they are today. They are problems because they are set up in such a way that the entire voting public has an interest in getting the best for themselves - and no interest whatsoever in conserving resources.

American exceptionalism. Our federal government is exceptionally poor at providing social services well.