I’ve thought for some time that no real “reform” or serious change in the Medicare system will ever occur until the elderly are visibly and palpably shut out or harmed by this very system they currently want preserved at all costs.  The elderly scare the politicians to death.  That’s why there’s no chance of any “top-down” change to the system.  Only when this politically powerful group demands that Medicare be abolished or relegated to the states for dismantling will this have a chance.  Ironically, failure to dismantle this and other entitlement programs guarantee the continuing bankruptcy of all those left living who will pick up the tab.

Imagine for a moment you are given the task of addressing a large group of Medicare beneficiaries, the purpose of which is to persuade them to advocate for the dismantling of Medicare.  Assume that everyone in the crowd you are addressing is wearing a t-shirt that says, “Don’t Touch My Medicare.”  What would you say?  How would you go about this?

You could go on about how the money is running out and eventually there won’t be any care for them at all.  This would get you nowhere.  You could say that as the money runs out, the doctors will be paid so poorly that they won’t see Medicare patients.  This would get you nowhere.  You could say that as the money runs out, that the government will set up death panels and those over, say age 67, with cancer or kidney disease will just be left to die.  This, too, will get you nowhere.  How do I know this?  All of this and more has been said/tried with no results.  Why?  Time preference.  The older we get, the less days we perceive we have remaining in our lives, the higher our time preference becomes.  I mean by this that little thought is given to future planning, a “live for the here and now” sort of mentality prevails.  This is no criticism, just a fact of human nature.  

So what could you say that would make a difference?   I don’t really know.  But here is something that occurred to me.  If you could get the crowd to understand that Medicare is like a monthly fruit delivery company and that the company delivering the fruit has gone bankrupt.  The executives of the Ponzi fruit company have left with all of the money and are hiding on the beach in the Cayman Islands somewhere.  Political pressure to continue the fruit deliveries is so intense that a judge orders another fruit delivery company to take up the slack….without compensation.  It just so happens that the owners of this conscripted and soon-to-be-bankrupt fruit delivery company are the children of those receiving the deliveries.  The parents, undeterred, continue to press for their fruit deliveries, all the while knowing that they are financially ruining their kids.

I know what you’re thinking.  This wouldn’t do any good either.  Is this logic sound?  I’m thinking it is.

G. Keith Smith, M.D.