Superstitions abounding - resistance to reforming Medicare funding - Column

The philosopher Alfred North Whitehead wrote somewhere along the line that societies are best understood by studying what isn't discussed. Because what isn't discussed is what is generally accepted, what is axiomatic. A fine example of the point was given when, with the revival of interest in Shakespeare in the nineteenth century, dramatists in London looked for specific dimensions of the Elizabethan stage -- looked and looked without success. Nobody who attended Shakespeare's plays had bothered to record the dimensions of the stage. It occurred to one researcher to look in the files of Philip II at the Escorial, where he found exactly what he was looking for: in a letter to the King written by his ambassador to Great Britain. The foreigner showed a natural curiosity over measurements Englishmen took for granted. One way, probably the best way, to inquire into what is taken for granted today is to tune in on a talk show.

Some social assumptions are deeply embedded, for instance that public education should be free. Others took root more recently, but some of these are accepted as social postulates. Yesterday the subject was Medicare, and the woman who called in informed the host that the Republican Party was taking health care away from the poor in order to swell the coffers of the rich.

The host made a valiant effort to point out the nature of the problem. He told her that while 10 per cent of the American people today are over 65 years old, in ten years that figure would increase to 12 per cent. Moreover, he said, every year there is progress in medicine, and although the age at which one dies is not infinitely elastic. Moreover, medical progress means more expensive procedures. Twenty years ago, 70,000 patients underwent bypass surgery at a cost of $10,000 to $15,000 each. In 1993, 330,000 bypass operations were performed at over $40,000.

Under the circumstances, said the host, Congress simply has to do something, and the Republican bill proposes to curb only the rate of growth of Medicare spending, the final figure continuing to grow. The Republican plan would reduce annual increases from 10 per cent to 7 per cent. In ten years, he said, the annual cost of health care would be equal to the entire sum of the budget today, $1.5 trillion.

The lady would not budge. Time was dissipated in challenges made to the figures used, but neither host nor guest ever touched on the planted axiom of the question, which of course has to do with the responsibility of others to take care of the health needs of the aged.

Who are the others? They are 1) those among the aged who have taxable income, 2) those younger than the aged who have taxable income or who pay payroll taxes, 3) corporations that pay tax.

Most of us subscribe to the convention that those in need should be helped. But it is only that, a convention. The host might have said to the questioner: Start from the beginning . . . Any expense for health care for the aged that is paid for other than by the recipient or his insurance company is, substantially, a gift. We tend not to think of it as a gift because the transaction has been desiccated by the conduits of vessels that transmit the gift. The money goes from the donor to the government in tax withholdings and makes its rugged way through bureacracies and agencies and hospitals and doctors' offices, to the patient, where it arrives somewhat emaciated from its efforts.

But it really is exactly that, a gift. But the point necessarily arises, What happens when the donors feel they are being asked to do too much? If a donor says, Look, last year I contributed a thousand dollars to the Medicare program, but I am not willing to increase that contribution by 10 per cent every year. What a lot of people are saying is that the aged are being asked to contribute money to the rich.

To penetrate that paradox -- that the donor's desire for a floor on their philanthropy equals a gift from the recipients to the rich -- is to disestablish one of our governing superstitions, and if Mr. Gingrich succeeds in this, he should invite the Spanish ambassador in to record how it was done.

COPYRIGHT 1995 National Review, Inc.
COPYRIGHT 2004 Gale Group