(8 of 8)
No one seriously believes that $270 billion can be pruned from Medicare through efficiency alone. If that--or anything close to it--is the goal, it will require reforms from all the categories discussed above. It is fair to ask seniors who can afford it to pay a bit more for what will remain a very sweet deal. It makes sense to move seniors into managed care, along with the rest of the country, and managed competition is the least coercive and most efficient way to do that--provided the politicians are honest about what is going on. And it is worth trying to make people more sensitive to the real cost of the health care they consume.
The seniors lobby is worried that if Medicare is turned into a cash payment or voucher, it will become indistinguishable from food stamps. It will be seen more like a welfare program, and people may start to wonder why we are financing gold-plated health-insurance welfare for the elderly, many of whom don't need it, when we do nothing for 41 million Americans--mostly workers and their families--who have no health insurance at all. The worry is reasonable. But so is the question.