TightWind is written by Kyle Baxter. Stay Hungry. Stay Foolish.

Ross Douthat:

Certainly telling seniors to buy all their own health care is a complete political (and ethical) non-starter. But telling seniors to pay for more of their own health care — well, it’s hard to see how else we can hope to reduce Medicare’s fiscal burden. Maybe the premium support/voucher model that the Ryan budget proposes isn’t the optimal way to do it. But every other mechanism for serious cost containment leads inexorably to a similar place.

All solutions to making Medicare solvent involve reducing how much Medicare will cover (which thus shifts costs onto seniors), dramatically reducing what treatments are covered, or dramatically reducing the number of doctors who will accept Medicare patients. Unless, of course, your plan is to significantly increase taxes on the middle class and wealthy. And that solution has even less a chance of ever seeing a president’s signature than Paul Ryan’s plan does.

Douthat’s point is important because whenever someone tries to propose a solution to Medicare’s insolvency, their political opposition immediately rushes to the microphone to make clear how it will destroy America’s elderly. The Republicans did it when Democrats proposed using savings from Medicare and the IPAB to eliminate “wasteful” treatments, and the Democrats did it with equal gusto when Paul Ryan made his budget proposal.

We don’t seem to be capable, as a nation, of serious, honest dialogue on this topic. Instead, we squander beneficial discussion for short-term political gain. If we are so tied to our factions, so unwilling to even entertain the idea that the “other side” might be just as genuine and honest in their intent as us that we will not even give them the benefit of the doubt for a few moments to have an actual discussion free of sound byte and rhetoric and posturing, then there isn’t much we can do. We’re finished.

In the post-Soviet haze of the 1990s, we lulled ourselves into believing that everything would work itself out, that we don’t need to worry much about what’s going on, because we’re America—we’re a successful nation, we’re meant to be successful, and it will all be right in the end. That’s comforting, because it allows us to talk about these issues like they’re just conversation topics at a dinner party—only valuable insofar as they provide lively conversation, forgotten by the time people drift out the door to their cars.

That’s an illusion. We aren’t the world’s preeminent power because we are pre-ordained to be. History is dotted with empires, convinced of their own immortality, that are now all but forgotten. We don’t have the luxury of staying where we are without any real effort. If we are going to retain our current success, and continue growing, we need to figure out how to solve these issues, and it starts with meaningful discussion. Until we can have it—until Republicans don’t wince with distaste when someone mentions they’re a Democrat, and vice versa—there’s very little we can do.