Cash grants instead of Medicare?

Matt Yglesias tweets:

Yes, I think converting Medicare into a straight cash grant to seniors makes sense.

They might rather have a servant, or a better car, or an apartment which doesn’t require them to drive, or to eat a better diet or join a better gym. Or maybe they would rather live it up, travel, and perhaps die at a younger age.  That’s what pro-choice means.

On the public choice side, this suggestion would turn seniors into an active constituency for health care cost control.

Nonetheless I propose a more modest version of the idea.  When people turn a certain age, allow them to trade in the current benefits package for a minimalistic package (set broken limbs and offer lots of potent painkillers), plus some of the rest in cash, doled out over the years if need be.  For some people, medical tourism will fill the gap.

But if a person wishes, he or she can keep the extant benefit structure and forgo the cash altogether.  No one is forced to take this deal.

Objections?  You might think that “health” has a special moral status of some kind, but keep in mind “health care” is only one way of many to better health care outcomes, so you still can favor increasing the degree of choice.

Paul Krugman calls for a public provision option in Medicare, a bit like the VA system.  He doesn’t mention letting people choose some cash instead.  We have gone from “Free to Choose” to “Free to Choose more government.”

He makes a good point at the end: “And what would terrify the right, of course, is the likelihood that genuine socialized medicine would actually win that competition.”

What would terrify the left, of course, is the likelihood that genuine privatized cash would actually win that competition.


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