Why Medicare and Medicaid cuts need to be off the table completely in fiscal talks

Democrats are coalescing in opposition to raising the eligibility age for Medicare as a sweetener to get Republicans to even start talking about revenue increases. That's fantastic, as far as it goes.

But there's good reason to leave Medicare and Medicaid completely off of the budget chopping block for the time being, and to be patient in considering reforms. Jon Cohn explains why here.

Contrary to what conservatives say and even many centrists seem to believe, the high cost of Medicare and Medicaid isn't a by-product of government inefficiency. On the contrary, Medicare historically has held down costs as well as, if not better than, private insurance on a per capita basis. That's thanks, in part, to the administrative advantages of a centralized government program and Medicare's enormous power to set prices. Medicaid is cheaper still, to the point where, honestly, it's underfunded. The programs keep getting more expensive, relative to inflation, because medical care keeps getting more expensive'and, in the case of Medicare, because of the increase in the number of people coming on the program.

The Affordable Care Act addresses, to an extent, the increasing costs of medical care'costs which are rising much more quickly in the private sector than in Medicare and Medicaid. And Obamacare is cutting costs for Medicare. Let the Affordable Care Act do its job and see how much it can do to contain Medicare spending.

But they don't have to stop at doing nothing about Medicare, if they really want to reduce health care costs. There's no reason not to put really progressive solutions into the mix. Like Medicare buy-in for people 55 and older, a younger, generally healthier cohort that would be paying premiums into the program. And why not finally allow Medicare to use its bargaining power to make prescription drugs for seniors cheaper to purchase, or at the very least allowing importation of cheaper medicines from Canada. Those are two, big-ticket possibilities.

And they can do it, as Greg Dworkin reminded us on Sunday, by citing the Very Serious Peoples' favorite Very Serious catfood commissioners Erskine Bowles and Alan Simpson. They included Medicare buy-in in their recommendations for strengthening the program. We know how much everyone loves Simpson-Bowles, so how about all of their suggestions being on the table?