Traditional Medicare is being threatened from two political directions. The current Republican coalition, on the right, simply dislikes social insurance in principle. It seeks privatization for its own sake. Another perspective, centrist and well established among political and economic elites, worries that the program is “unaffordable,” whatever its basic merits. Defenders of traditional Medicare need to address both threats by explaining why the budgetary fears are misconceived and why privatization is simply a bad idea. In order to do this, they need to take the budgetary high ground, argue more strenuously for short-term cost controls, and criticize the extra spending that the Bush administration has used to encourage private plans within Medicare. Defenders of social insurance should also seek good policy and political allies by proposing that Medicare's network of providers, prices, and administration be made available to employers (and other pools) in much the way that self-insured groups currently rent networks from private insurers.

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