Time to Pull the Plug on Medicare?

I applaud Michael J. Boskin’s observation that Medicare is an “autopilot entitlement growth” (“Clinton’s Medicare Plan Merely Postpones the Day of Reckoning,” Times Board of Advisors, June 16). Indeed, our government administers the program like a “zero-sum” game wherein the monetary increases each year do not offset the growth in expenditures, so those supplying the services receive less each year per unit of service provided. But what does one expect when the promised benefits approach infinity?

For instance, check out the operating room schedule at any major hospital this week and see how many folks in their ninth and 10th decades of life are having surgery. The procedures are “medically indicated” in the sense that the patients have symptoms that promise to be alleviated by the proposed procedures, and they are likely to survive the surgery and recover to live more life. But is it appropriate for the young of this country to have a substantial part of their pay docked to pay for this? Shouldn’t the recipients of the medical services use their own money to fund these benefits?

A program that attempts to restrain growth by squeezing the people providing the service, rather than those it entitles, does little to restrain the demand for services but much to diminish the quality of those services. Let’s admit the program promised too much, issue voucher checks until the program can be unwound and let folks resume personal responsibility for this area of their lives. What’s it to be: open-heart surgery or funds for the grandchildren’s college fund? A new hip or a new camper? It’s your money; you decide.

DR. GREGORY E. POLITO

Whittier

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I would suggest that Mr. Boskin ignores the big picture. The issue with Medicare and, indeed, all of health care in the United States, is providing adequate, affordable care to the public, not a Republican-versus-Democratic solution. I would suggest that the real issues are the following:

* Removing from the system the excessive profits to middlemen.

* Making reasonable decisions on how to ration health-care dollars.

* Ensuring that all Americans are adequately provided with at least a basic level of care.

* Educating the American public about the realistic expectations of what care can be provided with some hope of efficacy. (Everybody can’t have everything all the time and forever.)

“Rationing” may be a dirty word, but it reflects the need to decide what expensive, possibly experimental, treatments will be provided for what diseases.

Unless these parameters are considered, the system will continue to spiral out of control no matter whose plan is in place.

DR. ROBERT A. SHIAPIRO

Topanga

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When I read the Times Board of Advisors column, I expect a thoughtful, astute, if not comprehensive, article.

However, Boskin’s column was just a series of political sound bites. While he correctly stated that the Democrats’ plan would not save Medicare, he also implied (by omission) that the Republicans’ plan would. Not true.

Politicians say that we need a bipartisan approach to fix these programs. However, you cannot fix a Ponzi scheme. We need nonpartisan restructuring of these plans that will pass the test of time.

ROBERT N. WINDSOR

Orange