Argument: Medicare shortfalls often conflated with Social Security

Issue Report: Privatizing social security


Paul Krugman. “Social Security Scares.” New York Times. March 5, 2004: “Medicare, though often lumped in with Social Security, is a different program facing different problems. The projected rise in Medicare expenses is mainly driven not by demography, but by the rising cost of medical care, which in turn mainly reflects medical progress, which allows doctors to treat a wider range of conditions.

If this trend continues — which is by no means certain when we are considering the very long run — we may face a real long-term dilemma that involves all medical care, not just care for retirees, and is as much moral as economic. It may eventually be the case that providing all Americans with the full advantages of modern medicine will force the government to raise much more money than it now does. Yet not providing that care will mean watching poor and middle-class Americans die early or suffer a greatly reduced quality of life because they can’t afford full medical treatment.

But this dilemma will be there regardless of what we do to Social Security. It’s not even clear that we should try to resolve the dilemma now. I’m all for taking the long view; when the administration makes budget projections for only five years to hide known costs just a few years further out, that’s an outrage. By all means, let’s plan ahead. But let’s set some limits. When people issue ominous warnings about the cost of Medicare after 2077, my question is, Why should fiscal decisions today reflect the possible cost of providing generations not yet born with medical treatments not yet invented?”