Which is Harder: Medicare or Social Security?

Eli Lehrer’s intuition is actually the opposite of mine:

In many ways, Medicare and Medicaid may actually be easier to modify than Social Security.  Those programs would still be able to accomplish their fundamental goals after reform. Most reform proposals for Social Security however would change the system fundamentally.

It seems the exact opposite to me. Social Security provides people with cash payments, that are linked in one way or another to inflation.  They of course would rather have higher benefits than lower ones, and there will be consternation as we debate any reform of this program.  However, if a specific Social Security compromise were agreed to (specific increases in revenue and/or decreases in benefits), then we could expect it to work more or less as expected.  And people would have a reasonable understanding of what benefits they would receive.  That is actually one of the benefits of fixing Social Security, because once fixed it really could be fixed and off the table.  Medicare is an entirely different animal because it purchases health care for beneficiaries, including innovations tomorrow that are unknown today.  And there is another very interested party to every Medicare transaction, namely providers.  Every dollar of waste, inefficiency and inappropriate care that is squeezed out of Medicare by whatever means is a reduction in someones income.  They won’t go quietly.  A real Social Security reform could be passed this year and put on auto-pilot.  Any Medicare reform will require endless tinkering; we will never be done with health care reform.

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