An ideology is a pattern of thinking that turns philosophies and suppositions into conventional wisdom accepted without question. That means that on a subject like the future of Medicare, alternative viewpoints are about as useless to a conservative as skepticism is to a believer in ghosts.
Recently, the most notable example of the conventional wisdom is Republican congressman Paul Ryan’s deficit-cutting budget proposal. His idea for Medicare is to turn it into a voucher program where beneficiaries receive a fixed allocation of money from the government, which they can then use to pay for medical services through a private insurance company. Though this plan would significantly cut costs for the government, it would put at risk many of the elderly whose vouchers were not enough to cover all their medical expenses. Recipients would have to negotiate with an insurance company for the lowest price. But full coverage could entail extra premiums to be paid out of pocket.
This plan is motivated ostensibly by the desire to reduce the cost of Medicare in the future as the program accommodates an increasing number of old people. Without such drastic steps, Ryan says, the United States will amass an insurmountable fiscal deficit in just a few years. One conservative commentator put the problem succinctly: “If we don’t reform the program, the country will go broke.”
Here the conventional wisdom speaks, but does it have the answers? And, for that matter, is it asking the right questions? Of course not. The conservative ideology forces the issue of Medicare into a marketplace model that is concerned more with retailing insurance policies than serving the medical needs of the elderly. It also undermines a highly successful single-payer national healthcare plan on the pretense of fiscal responsibility.
Here are the questions the ideology doesn’t ask: Why can’t the American people provide the best and most effective medical care for all of our elderly citizens? And, how can we accomplish this goal and fund it in a fiscally responsible way?
The conventional wisdom responds by saying that health care is an individual responsibility and must be worked out as far as possible in the marketplace. In addition, Medicare in its present form is a government entitlement and like all big government programs it’s inefficient and disempowers individuals. The fiscally responsible thing to do is to severely cut the program to avoid large government deficits.
In short, the conventional wisdom tells us the Ryan plan will work because, as everyone knows, 80 year olds are tough customers when it comes to negotiating with big business for fair prices. It also tells us that caring for the elderly is less important than holding the line on taxes for the wealthy and continuing huge government subsidies for big oil and big agriculture. Unfortunately, fair taxes and reduced subsidies, which would actually cut the deficit and save Medicare, have been taken off the table. To conservatives, blinded by their ideology, these options are simply invisible.