The current debate over how Medicare should be structured has seemed to me to be nothing more than each side declaring that their federally funded healthcare program is better than the other side’s. Paul Ryan’s plan to make Medicare (10 years hence) into a voucher system has been hailed by many as a serious and responsible modification of a program that in its current guise will soon bankrupt the country. But in reality it is nothing more than another welfare program that in the unlikely event it were enacted would also end up bankrupting the US. Furthermore the bulk of our population wants Medicare to continue in its current form irrespective of the fiscal consequences.

Frederich Hayek in The Constitution of Liberty (1959) remarked that social welfare programs were like drug addictions. He also intimated that this insight was not an original idea. Despite the age of the observation, it does not seem to have gained much currency. Drug addiction has four components: habituation, dependence, tolerance, and withdrawal. Consider the public’s  relationship to Medicare. They can’t imagine life without it. They are totally dependent on it. They need more and more of it. No amount of it will permanently satisfy. And if you take it away they go berserk. In other words, they are addicts.

Realistically, there is no way for the government to fix this program. Efforts at reform will meet the same end as the War on Drugs. Almost no one has realized that this program cannot be fixed. The ad showing Paul Ryan throwing Granny off of a cliff depicts the dilemma we’re in and Ryan wants to continue the program, albeit in a slightly different form. His plan will lead to bankruptcy just as certainly as the current program.

Andrew McCarthy has discovered the true nature of our problem with entitlements. His article is worth a read; he thinks Medicare should be ended. While he probably is right, ending Medicare  will take an asteroid hitting Earth before this country will actually consider the possibility. Anybody who has seriously dealt with addicts knows how difficult it is to successfully treat them and how high the relapse rate is. Medicare addiction makes that of heroin look like nail biting. We are stuck with it and its consequences. In a democratic society social welfare programs like Medicare cannot be rendered harmless nor can they be eradicated once established .