The Hoover Dam, seen in 1935, is a good example of the government taking a… (Los Angeles Times )
Budget discussions in Washington these days always seem to deteriorate into arguments over what government is supposed to do for its citizens, and what should be left aside. Is the reach of government strictly defined in the Constitution? Or tradition? And, if so, whose "tradition"?
Here's a rule of thumb to consider for when government should take a role in providing a service: When it's cheaper.
That doesn't mean cheaper merely in a narrow sense, such as cheaper at the cash register, or for some people rather than others. Government can always achieve that end simply by subsidizing things by fiat. Congress could cut the cost of tablet computers simply by deciding to subsidize every household's purchase by, say, $50 or $100. The same thing goes for dishwashers, or fine crystal.
Rather, it means cheaper for the economy or society at large. And that points us to the idiocy of an unaccountably popular proposal aired in connection with Washington's "fiscal cliff" cabaret: raising the eligibility age for Medicare.
There seems to be a consensus developing that raising this age to 66 or 67, from today's 65, would be a fairly painless way of demonstrating our commitment to fiscal responsibility. You're all living longer, so what's the big deal? — you'll have plenty of time to enjoy the fruits of Medicare, if you're a little more patient.
Best of all, the change would save the federal budget $5.7 billion in 2014 alone.
Calculations such as these typically are made to look good by considering only one side of the ledger, the side showing the cost to government accounts (often only the short-term cost). This is a handy trick that can be applied to almost any situation, the way the ShamWow can mop up any spill.
Has the government spent too much on maintaining roads and bridges? Spend less! This does wonders for the federal budget. Of course, it does horrors for the budgets of everyone else.
What's on the other side of the Medicare-age ledger? Plenty. As the Kaiser Family Foundation calculated last year, health insurance for 5 million people would be affected for at least a year. Of that group, 42% would stay on their employers' insurance (including some as retirees), 38% would buy private insurance through the exchanges set up under the 2010 healthcare reform act, and 20% would land on Medicaid.
Two-thirds would pay more for insurance than they would have paid under Medicare, for an aggregate net increase in out-of-pocket costs of $3.7 billion. The shift of more-elderly members into the commercial insurance pool would drive up premiums for the non-elderly by an average of $141 per enrollee. Costs to employers of keeping these workers in their plans would rise by $4.5 billion a year, and Medicaid costs for states would rise by $700 million.
By the way, the higher costs would hit middle-class seniors especially hard.
Put it all together, as health economist Austin Frakt did, and you find that saving that $5.7 billion on the federal books would cost society as a whole $11.4 billion. To paraphrase Jerry Seinfeld, this is how you save money in the Bizarro world. It does nothing to improve Medicare. It does nothing to hold down healthcare costs. It does nothing to improve the health of the target population.
House Budget Committee Chairman Paul D. Ryan (R-Wis.), who recently ran and lost a race for a certain high government post, was a master of this bookkeeping with one eye squinted shut. Ryan's plan for Medicare involved simply shifting healthcare costs from the government program to private insurers and sticking seniors with more of the costs.
The bipartisan Congressional Budget Office forecast that these would be one-third higher by 2022 than they would be under Medicare. Net reduction in healthcare spending, economy-wide? Less than none.
Ryan is not the only politician playing with this stacked deck. In 2010, New Jersey Gov. Chris Christie killed a project to build two new train tunnels to carry passengers between his state and Manhattan, where hundreds of thousands of his constituents work. Christie's argument was that the cost was too much for New Jersey to bear. (Though the federal government would cover most of it.)
But Christie simply ignored the value of the benefits provided by the project — billions of dollars in new economic development, an increase in rail ridership and a gain in air quality thanks to reduced auto traffic, and reductions in travel delays for commuters.
About $13 billion would be pumped into the local economy via wages and increased business activity during the construction phase alone. Christie, whose blustery avoirdupois is supposedly so appealing it may float him to a presidential run, didn't care to do the arithmetic that showed the project was a bargain, not a burden. Such are the limitations of bluster.
The broad economic view has undergirded some of the most important government projects in our history.