Coruscation

There are basically two ways to cut back on the government health care spending.

(a) From the top, a body of experts can be empowered to make rationing decisions. This is the approach favored by President Obama and in use in many countries around the world.
Alternatively,

(b) at the bottom, costs can be shifted to beneficiaries with premium supports to help them handle the burden. Different versions of this approach are embodied in the Dutch system, the prescription drug benefit and Representative Paul Ryan's budget.

We'll probably need a mixture of these approaches to figure out what works. Instead, Republicans decry the technocratic rationing model as "death panels." Democrats have gone into demagogic overdrive calling premium support ideas "privatization" or "the end of Medicare."

Let's be clear about the effect of this mendacity: We're locking in the nation's wealth into the Medicare program and closing off any possibility that we might do something significant to reinvigorate the missing fifth. Next time you see a politician demagoguing Medicare, ask this: Should we be using our resources in the manner of a nation in decline or one still committed to stoking the energy of its people and continuing its rise?