Medicare counterfactuals

A while back Tyler Cowen asked a question:

If I were a progressive I would be wondering right now whether Medicare was a tactical mistake.  The passage of Medicare meant that most old people get government-provided health care coverage.  Yet the way to get things done in this country, politically, is to get old people behind them.  Further health care reform doesn’t now seem to promise much to old people, except spending cuts on them.  Given their limited time horizons, old people don’t so much value system-wide improvements, which invariably take some while to pay off.

If Medicare had not been passed, might this country have instituted universal health care coverage sometime in the 1970s?

I wonder also, if Medicare had not passed would there be a viable Republican Party (or conservative movement) in this country at all today?

In many ways, the advent of the current entitlements gave the conservative movement a reason for being.  If Medicare had not passed, or Social Security before it, or any of the major progressive pieces of legislation, would the GOP be as popular as they have been the past 30 years?  I ask this because the nature of the conservative movement has been one of opposition – especially since the end of the Cold War.  This has provided cover for a Party with few ideas and few solutions but plenty of things to run against. Faced with a largely uninsured elderly population (without Medicare, and largely savings-free without Social Security), I’m not sure that the Republicans would have nearly the same popular support they have today.

This isn’t even intended as an endorsement of those programs or really a judgment of entitlements at all – only an observation of the state of affairs on the right once you strip away defense and culture war stuff.  What you’re left with is the party that is against the entitlements (except Medicare lately, of course) and not much else.

Now, conversely, if Medicare hadn’t passed and some other, broader healthcare bill had passed then we’re back in the position we’re in now. Which makes me wonder if entitlements aren’t actually very beneficial to conservatives, since they give the conservative cause so much to be against.  This may be a hugely cynical thing of me to say, but there it is.  Nor am I saying conservatives shouldn’t be against entitlement spending, only that there has been very little in the way of substantive efforts to actually find ways to reform entitlements that the American people seem willing to accept.

So maybe, deep down, conservatives should be cheering the fact that – even if it isn’t until February – we’re going to have a huge overhaul of our healthcare system.  This might have huge existential benefits for the conservative movement.