So Medicare stays roughly the same, but every time you receive medical care you also get a bill. You don't have to pay it, though. It's just there for accounting purposes. When you die, the bill gets paid out of your estate. If your estate is small or nonexistent, you've gotten lots of free medical care. If it's large, you'll pay for it all. If you're somewhere in between, you'll end up paying for part of the care you've received.



Obviously this gives people incentives to spend all their money before they die. That's fine. I suspect they wouldn't end up spending as much as you'd think. What it does mean, though, is that Medicare has first claim on their estate, not their kids. But that seems fair, doesn't it?

KEVIN DRUM treats us to some stimulating inside-the-pine-box thinking about Medicare reform:

That does seem fair, at first blush. Mr Drum says, "Conservatives should love this idea". And why shouldn't they? Making ex-people posthumously pay whatever their estates can bear, while reducing the riches that flow to their heirs, strikes a double blow for individual responsibility. Mr Drum does recognise that his plan for beyond-the-grave financing faces serious practical obstacles, but I fear he has not fully grasped the game of regulatory whack-a-mole such a plan would set in motion.

I've got a better idea. Don't give the elderly rich any government money for health care. Let them pay for it, because they're rich! And give other seniors just the assistance they need—no more, no less—to buy a health plan of a certain minimum level of coverage. Now, I know this is a fantastical idea for crazed, science-hating, Rand-thumping Jacobins, amounts to destroying Medicare as we know it, and is good for nothing but losing elections. But for all that it seems at least as practical as picking over dead peoples' estates.

Anyway, none of this really matters. America is not actually in the market for creative proposals to put Medicare on a sound footing. Slate's David Weigel explains how New York Democrat Kathy Hochul took a page out of the 2010 GOP playbook and scared old people about Medicare all the way to a seat in the House of Representatives:

Hochul started with, and stuck to, one simple message: Vote for me, and I'll protect Medicare. After Ryan introduced his budget, she honed in on the part of it that turned Medicare from a guarantee into a "premium support" plan for people who are currently 55 or younger.

A split conservative ticket didn't hurt, either, but Mr Ryan's voucher plan surely helped a lot. (Mr Ryan's plan, part of his larger budget bill, went down to defeat in the senate yesterday, along with three other proposed budgets, which all fared even worse.) Pledging to do nothing about Medicare but to "protect" it from the depredations of would-be reformers promises to remain an excellent electoral strategy. Meanwhile, something needs to be done about Medicare. I think my colleague at Free Exchange has nailed the political dynamic:

Both parties have, somewhere inside them, a serious proposal to reform Medicare. If they thought they could be elected by offering such a plan, they would do so. But any serious attempt to reform Medicare is going to be unpopular because it will cost the elderly something, and the elderly are on the way to becoming 30% of the voting population. Thus, the opposing party is inevitably going to use such a proposal to kill the other at the next election without advancing an alternative. And since both parties know this, the only Medicare plans they offer voters will be lemons.

I would add: that nearly a third of the voting public is 65 or older does not quite capture the overwhelming electoral heft of seniors. Retirees are disproportionately likely to actually show up at the polls. Moreover, the interests of seniors are more unified than those of younger voters whose electoral might is divided between often competing and offsetting interest groups. The votes of small business owners and school teachers tend to cancel each other out, but America's silver foxes constitute a more or less consolidated force fighting for the protection of old-age entitlements. Even reform proposals that would preserve the status quo system for those at or near retirement are out of the question. Once it is conceded that Medicare is touchable, what's to keep the selfish young punks who don't want their country to collapse under the burden of entitlement spending from touching what is owed to the Greatest Generation and their supremely entitled Boomer offspring, who have already sacrficed so much?

(Photo credit: AFP)