- Neither Merrill Goozner nor I was suggesting that "estate preservation" was a paramount goal of health-care policy. He was mainly making fun of the ominous term "death tax" in estate-tax debates. The real point is that removing Medicare's universal coverage would expose all families below the very-rich level to the threat of unbounded, possibly catastrophic late-in-life medical costs.

- Of course the answer is not just to have Medicare pick up the tab for more of everything. The central reality of the whole health-care mess is that finally someone has to pay for all the new devices and drugs. Therefore the challenge is figuring out which payment/insurance system will achieve the best combination of

(a)" bending the curve" of medical-spending increase,

(b) spreading the insurance risk among the population and across each person's stages of life, to spare people anxiety about ruinous late-in-life bills; and

(c) applying market incentives wherever possible within the strange economy of health care, for people needing care and people providing it too.

Any one of these is hard to achieve; optimizing for three at once is extremely difficult. But -- to return to the original point -- undoing Medicare coverage would be a big step backward on the first two fronts, and negative to neutral on the third.

