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It is axiomatic in medical education that an individual is not a mature physician until having learned to assume full responsibility for the care of patients. Thus, the defining educational principle of residency training is that house officers should assume the responsibility for the management of patients.

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By Edward Zelinsky

Receiving my AARP membership card was one of the truly traumatic events of my life. I had marched for civil rights. I had protested the war in Vietnam. I walked the streets for Gene McCarthy. I was a legitimate Baby Boomer. How could this have happened to me?

My wiser and more self-confident spouse took it in better stride. Doris quickly became adept at pulling out her AARP card and demanding old-age discounts, as I stood sheepishly aside.

My personal disquiet about my AARP card reinforced my deeply-seated, policy-based misgivings about the AARP. President Clinton and Speaker Gingrich could have emulated President Reagan and Speaker O’Neill by negotiating a reasonable, bi-partisan approach to Social Security. At that time, increasing the retirement ages for Baby Boomers and other similarly modest measures would have brought Social Security’s projected payments into line with its expected revenues, with only minor impacts on future retirees.

There were many reasons such a deal didn’t happen during the Clinton years, but the AARP’s strident opposition was chief among them.

As the financial problems of Social Security and Medicare became more acute, I became increasingly troubled by the AARP’s refusal to address them. The AARP’s effective opposition to reforming these entitlement programs has implemented perfectly the ethic of Baby Boomer narcissism.

I was accordingly surprised and reassured to learn that the AARP has at last acknowledged the need for us geezers, i.e., its members, to reform Social Security benefits for the financial sake of our children and grandchildren. As a mushy moderate, I am convinced that there is a balanced package of tax increases and benefit reductions which can allow the Baby Boomers to retire without bankrupting our offspring.

It is good news that the AARP has belatedly recognized this reality.

Medicare will be tougher to reform. It is now finally sinking in that the Independent Payment Advisory Board President Obama and Congress created as part of the health reform package will effectively ration medical care through its control of Medicare’s payments to health care providers. This should surprise no one: Rationing is how government outlays are controlled. Medicare’s outlays must be controlled.

The same is true of the consumer-driven approach to controlling Medicare expenses proposed by Rep. Paul Ryan. The Ryan plan would place greater responsibility on Medicare consumers to control costs. This approach is also going to be necessary to control Medicare outlays.

Determining the right mix of these two approaches is going to be a difficult task. Regrettably, neither Republicans nor Democrats are now prepared to undertake the serious enterprise of governing.

It would be good for the AARP to also raise its voice on behalf of the cause of Medicare cost reform.

However, for now, I’ll take what I can get. It is progress for the AARP, however gingerly, to acknowledge that Social Security entitlements for the elderly must be curbed in the interests of national solvency and the futures of our children and grandchildren.

But I will still step aside while Doris demands the elderly discount.

Edward A. Zelinsky is the Morris and Annie Trachman Professor of Law at the Benjamin N. Cardozo School of Law of Yeshiva University. He is the author of The Origins of the Ownership Society: How The Defined Contribution Paradigm Changed America

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By Edward Zelinsky

The United States is in the midst of a “free lunch” campaign in which Republicans and Democrats alike promise painless resolution of our budgetary problems. As a result, neither party will have an electoral mandate for the hard choices necessary to tackle our fiscal quandaries. Both parties are squandering an important opportunity to mold public opinion and set the stage for meaningful budgetary discipline.

In a recent survey of the U.S. economy, the Organization for Economic Co-operation and Development (OECD) concluded, with considerable understatement, that “the United States faces challenging budgetary prospects.”

This conclusion should surprise no one. The history and current reality are there for all to see: In 2001 and 2003, the Bush Administration and Congress reduced federal income taxes significantly. Instead of decreasing federal spending to pay for these tax reductions, the Bush Administration presided over significant increases of military and domestic outlays as well as unrestrained growth of so-called “entitlement” spending – Social Security, Medicare, Medicaid. The Obama Administration has continued and exacerbated this trend. At the state and local levels of government, budgetary prospects often even worse as unfunded pension obligations and unfinanced retiree health benefits balloon.

To be sure, there is much contemporary political rhetoric about the need for fiscal discipline. President Obama has appointed a National Commission on Fiscal Responsibility and Reform. Tea Party candidates successfully exploit growing public anxiety about budgetary deficits.

However, none of this should be taken too seriously. President Obama’s deficit commission is scheduled to report only after this November’s elections. We have become inured to public images of Tea Party activists denouncing federal spending – except for their own Social Security and Medicare payments. The House Republicans’ “Pledge to America” promises fiscal responsibility while also refusing to reduce defense spending or spending which affects seniors.

The net result has been a free lunch campaign in which Democrats and Republicans alike promise budgetary discipline but refuse to specify how they will achieve it. The bi-partisan message to the electorate is that public deficits can be controlled without pain.

This, of course, is untrue.

Undoubtedly, it is considered wise politics to promise tax reductions and vague spending restraints while ignoring the tough choices necessary to put our budgetary house in order. However, in the long run, the promise of a free lunch will prove to be poor politics.

Empty, anodyne campaigns result in elections without mandates. Postponing the real discussion until after the election forfeits the opportunity to establish an electoral basis for the painful actions necessary to eliminate federal and state budget deficits.

In ordinary times, off-year elections are low key affairs in which the President’s party typically loses some or all of the congressional seats it gained in the prior presidential election. Conventionally, such off-year elections are preceded by locally-oriented campaigns.

However, these are not ordinary times. We are barely recovering from the worst economic contraction since the Great Depression of the 1930s and confront current and projected budgetary deficits of unprecedented magnitude. In this historically unique setting, the 2010 campaign is an opportunity for the two parties to form electoral mandates by specifying how they wil

Elvin Lim is Assistant Professor of Government at Wesleyan University and author of The Anti-intellectual Presidency, which draws on interviews with more than 40 presidential speechwriters to investigate this relentless qualitative decline, over the course of 200 years, in our presidents’ ability to communicate with the public. He also blogs at www.elvinlim.com. In the article below he looks at the effects of health-care reform. See Lim’s previous OUPblogs here.

House Democrats have passed the health-care reform bill. Assuming Senate Democrats pass the accompanying reconciliation bill, this is a punctuating moment in the history of the American state, and a game changer for the politics of Elections 2010.

Since the New Deal, Democrats have embarked on a state-building enterprise. Democrats have expanded the functions of the state because they believe that individuals left by themselves and markets do not give us optimal levels of economic rights, civil rights, or health-care rights. Some Republicans were on board for a while, but today most see the accumulation of governmental responsibilities as the road to serfdom.

I am not sure that health-care reform takes us one step closer to socialism, but the Republicans are correct in their public statements that health-care reform will effect a major reconfiguration of citizens’ relationship with the state, and in their private sentiments that it is very difficult to roll back the state once it has been bloated. There was a time when bills calling for federal funding of roads between states were vetoed, when a federal income tax was unconstitutional, when investment banks were not regulated. None of these federal prerogatives are controversial today. Ted Kennedy and Barack Obama are correct that health-care reform is about the character of our country, though it might be fairer to say that it is about the evolving character of our country, because the developmental history of the expanding American state has paralleled America’s steady transition from pluribus to unum.

There are now 32 million new constituents of the (health-care) state, even if many will end up purchasing insurance from private exchanges. They are going to be committed to the state as wards are committed to their patron, and as seniors have come to love Medicare. Americans may not like the state, but our appetite for government tends to increase once we have been touched by its largess. Barring catastrophic implementation failure (because Medicare isn’t exactly a perfect program and it remains popular), the Democratic Party has just earned itself a sizable new constituency, not unlike what it did when FDR passed pro-labor legislation, or when the Republican Party handed out pensions to civil war veterans. At least some of these 32 million will go to the polls in November, and Republicans who have been fighting very hard to kill health-care reform know this. But because health-care reform has passed, Democrats have at least a fighting chance of keeping their congressional majorities when this seemed all but impossible a few weeks ago. For the first time since Scott Brown’s election to the Senate, the momentum is back in the Democrats’ court.

Barack Obama’s poll numbers are going to go up too. He lost many independents over the past year because he was seen to be too liberal, but he lost just as many  because he was seen to be incompetent in delivering change. When members of congress were chanting “Yes, We Can” on the floor of he House on Sunday night, we know that some of the old magic is back. He has done something that the last popular Democratic president, Bill

Elvin Lim is Assistant Professor of Government at Wesleyan University and author of The Anti-intellectual Presidency, which draws on interviews with more than 40 presidential speechwriters to investigate this relentless qualitative decline, over the course of 200 years, in our presidents’ ability to communicate with the public. He also blogs at www.elvinlim.com. In the article below he looks at Howard Dean. See Lim’s previous OUPblogs here.

The year is 1964, the high watermark of Liberalism. Lyndon Johnson takes 61.1 percent of the popular vote in his election contest against Barry Goldwater, an electoral feat that was bigger than Franklin Roosevelt’s 60.8 percent in 1936 and one that has not been surpassed in the years since. The Democratic tsunami sweeps down Pennsylvania Avenue to the Capitol, where Democrats would out-number Republicans two to one in the 89th Congress, and in the Senate they take 68 seats – the biggest supermajority held by any party to this day. The era of Liberalism had entered its Golden Age.

Unified by the inspiring memory of John Kennedy, Democrats were able to enact health-care legislation that even Franklin Roosevelt, the father of modern Liberalism did not have the stomach to attempt as part of his New Deal. It would be Lyndon Johnson, not Harry Truman, not FDR, and not his counsin, Theodore Roosevelt (running as the Progressive Party candidate in 1912) who would enact the single biggest health-care legislation in US history, offering single-payer, comprehensive health-care benefits to seniors over the age of 65 (Medicare) and an option for states to finance the health-care of the indigent (Medicaid) in the Social Security Act of 1965.

We remember the New Deal, and perhaps the Fair Deal, but it is the Great Society that is the apotheosis of 20th century Liberalism. And if 1965 is Liberalism’s high water-mark, then those who would stymie health-care reform today because of the lack of a robust (or indeed, any) public option have gravely gotten their decades mixed up.

There was a time when Liberals did not have to call themselves “Progressives.” That was four decades ago, when Lyndon Johnson attacked Barry Goldwater for wanting to roll back social security and openly campaigned for a further expansion of the welfare state. Times have changed. Today’s Progressives must cagily wrap their Liberal agenda with talk of choice, competition, and bending cost curves. And if the era of Liberalism as FDR and Johnson knew it is over, The Age of Reagan lingers on in the Tea Party Movement. Despite his aspiration to build an even Greater Society than Johnson, Barack Obama’s electoral mandate is 18 percent short of what Johnson possessed in 1965; the Democratic majority is the House is much smaller; and, despite the new cloture rules post-1975 in the Senate which has reduced the fraction of votes needed to end debate from 2/3 to 3/5, Joe Lieberman et al remind us every day that the Senate is anything but filibuster-proof.

To Governor Dean and his compatriots, it is 2009, not 1965.

Accept the fact – life is a pre-existing condition. Any health insurance that denies this fact is not health insurance; it’s death insurance. Sad to say, that’s what the United States’ so-called health care has become. Except for the rich, of course. The poor don’t count. The middle class don’t count. They’re going to die anyway. May as well be sooner as later.

The opposition to healthcare reform comes mainly from Republicans but also from a small group of “blue dog” Democrats, and it’s gotten ugly. These politicians, elected to serve the American people are, instead, serving health insurance and pharmaceutical lobbyists. Once again, the power of money trumps the health of a nation.

Forget single-payer – the plan some 72 percent of polled Americans want. It’s socialism, cry the corporate flunkies. But the two government programs that really help people – Medicare and Social Security – are both socialism. Without those programs, millions of Americans would be suffering more than they are. They’re the only two programs the United States has that return benefit to citizens who have worked and paid taxes all their lives. Why not solve the health crisis by extending Medicare to everyone?

It’s striking that the same crowd of public citizens who oppose single-payer health insurance didn’t mind socializing debt through the bank bailouts. Okay for the government to be the single payer in those transactions. Mercy! What would happen if we really had universal health care in the United States like most other civilized Western countries? If we cherished and nourished that pre-existing condition we call life instead of denying it coverage? The big bad wolf of socialism would eat up some of those inflated profits of health insurance and pharmaceutical companies. Oh mercy, health care just might become affordable for our citizens if we had a single-payer system. People might go for check-ups more often. Maybe our citizens would be healthier and wouldn’t have to wait until they are so ill, they have to use hospital emergency rooms as their family physician. Sickness is costly. Untreated diseases that reach advanced stages when diagnosed require the most expensive treatment. Fostering health is a lot more cost-effective than the current neglect and denial built into our wretched healthcare system. It’s no accident our health care is the most expensive in the world but our outcomes are among the worse. In our current system, only the lives of the rich seem worth saving. Do they think they aren’t going to die?

In their zeal to “kill” healthcare reform, Republicans have declared war against President Obama, predicting a defeat will be the President’s “Waterloo” and will “break” him. Isn’t there something a bit unpatriotic about trying to bring down a President who is heroically working to repair the severe damage inflicted on the United States by the previous Republican administration? The gang that for eight years self-righteously promoted itself as the party of family values and country now turns its back on both and acts as if it wishes nothing other than revenge against the American people for electing President Obama.

As the President said in his press conference about healthcare last week, this isn’t about him. It’s about the health of the American people and the future of our economy. But nobody gets rich looking out for the poor and middle class in this country. Only the corporate rich deserve tax breaks, health care, and bonuses.

The party that racked up the largest deficit in American history – more than that of all previous Presidents combined – now complains about the cost of healthcare reform. Do they really think Americans are too stupid to see through the hypocrisy?

What a sorry bunch of human specimens that would rather, through their cynical inaction and sudden onset of fiscal conservatism, kill a healthcare bill that could prevent so much suffering and save people’s lives. Life is cheap. It’s health industry dollars that line politicians’ pockets.

As for the blue dog Democrats, their opposition to healthcare reform places them in the same alternate universe as the right-wing Republicans who have sold their souls to lobbyists and turned their backs on the only condition that afflicts any of us -- life.