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The Good Old Days? : The Republicans Would Have Us believe That The United States Has Gone Downhill Since The '60s--and Government is The Reason. But Medicare Alone Proves Government Can Do Good.

November 05, 1995|Gregg Easterbrook | Gregg Easterbrook is a contributing editor to the Atlantic Monthly and author of "A Moment on the Earth: The Coming Age of Environmental Optimism" (Viking)

BRUSSELS — This year's mainly Republican effort in Congress to roll back federal health, safety and environmental initiatives, while deep ly cutting welfare and Medicare, seems an attempt to return to the status quo of 1959, shortly before most such programs began. Until the dawn of the 1960s, received conservative political nostalgia now has it, America was a splendid place. No bureaucrats on our backs, no McGovernicks (as Newt Gingrich calls them) in office, no red tape restraining the economy. If only we could wipe out those well-meaning but failed government programs and return to the milieu of 1959--maybe with laptop computers and speed-of-light pizza delivery added--the national grandeur would be restored.

It's hard to think of many ideas stranger than the notion that the United States has gone downhill since the 1960s. In several troubling areas--notably crime and the breakup of the family--trends of recent years have been steadily negative. But, by most measures, the United States of 1995 is a dramatically better place to live than the United States of 1959. The economy is more than twice as big, in real-dollar terms; poverty has declined, despite a larger population; most people are healthier and live longer; the environment has improved; most jobs are less dangerous; most formal discrimination has ended; education levels are at an all-time high; personal freedom has never been greater; conveniences once reserved for the rich, such as air travel, have become commonplace; the threat of nuclear war has dramatically declined; the list goes on.

These steady improvements in most aspects of American life happened during the very period when government regulations increased and government programs grew. In the current conservative, anti-government critique, we'd somehow be better off without federal programs. Yet, returning to the day before many such programs were enacted would mean a huge step backward in health, safety and prosperity.

Consider Medicare, the health-care program for senior citizens, that Republicans in Congress last month voted to reduce by $270 billion over seven years. Today, it is taken as a given in American politics that the elderly, as a group, are financially secure, with a lower poverty rate than other segments of the population and a generous allotment of federal health-care subsidies. But the reason the elderly have become financially sheltered is not market forces or social forces: Rather, it is government programs.

Social Security, created in 1935 and expanded dramatically in the 1970s, has ended most cases of senior-citizen impoverishment--a horrifying social problem of the 1950s and one that its victims, people at the end of their earning power, generally could do nothing about.

Medicare, created in 1965, has both extended the life expectancies of senior citizens and improved their quality of life--by making common such advances as removal of cataracts and heart surgery. In turn, because Medicare is generously funded, senior citizens can enjoy ever-improving health care without going into hock to pay for it. The statistical bottom line: In 1965, 28.5% of senior citizens lived below the poverty line; today, only 12.9% do.

By any reasoned assessment, U.S. senior citizens are much better off as a group in 1995 than they were in 1965. That does not mean Medicare should be untouchable; its budget growth is a clear problem. But cuts ought to be cautious, acknowledging a central truth: Medicare is a federal initiative that has worked very well, accomplishing what it was designed to do--namely, improving the health of a broad segment of society. Instead, most of this year's rhetoric from Republicans in Congress has been to portray Medicare as just some ponderous government walrus wallowing in a pool.

Today, we can take for granted the existence of sound health care for those over 65 precisely because a big, expensive, sweeping federal program was enacted. Many Republicans in Congress won't give an inch on this, pointing to Medicare's cost as a proof of government failure, while saying little or nothing about the program's accomplishments.

Where Medicare is quite effective on the key point of care delivery, Medicaid, the health program for the poor, often delivers care of dreadful quality. For two decades, most measures of the health of senior citizens have been pointed upward, while many measures of the health of the poor point down. Instructive here: Medicare is a federal program; Medicaid is run by the states. Yet, observing a successful federal health initiative compared with deeply troubled state health programs, many in Congress today ridicule federal efforts, while praising the states.

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