Nothing brings out America’s political schizophrenia like Medicare. The program is universally popular with consumers, and universally seen as a necessity by providers. Despite these facts, the reality is that Medicare is Socialism. The program ranks behind only Social Security and public education (by percentage of GDP) in the United States welfare state (with police, firefighting, and Medicaid ranking behind it). In 2009, literally millions of independent and conservative voters were convinced to fight health care reform on the grounds that it damaged Medicare, the United States’ preeminent example of Socialism. Confusion reigns supreme!
But American politics likes when a program inspires schizophrenia, because it means American politicians can use the program like a weapon. During the aforementioned debate over health care reform, Republicans (who fought Medicare’s enaction in the 1960′s and have spent decades trying to kill it), used the cuts to Medicare against the Democrats. The Affordable Care Act provides for $500 billion worth of direct cuts, reimbursement changes, and quality programs to Medicare over a 10 year period. None of the cuts will deny coverage or service, focused as they were on reductions designed to force providers to be more efficient, and the elimination of subsidies for the Medicare Advantage Program. This idea sounds suspiciously like fiscal responsibility, but it was a convenient and well-used weapon in the conservative arsenal circa 2009.