Peter Lawler and James Poulos wonder if we have what it takes to make the sacrifices needed to get the federal budget under control. I think the answer is yes, but only because we have no choice. It also depends on what we mean by sacrifice. Old (and near-old) people are terrified of any changes to the existing system. They can see the enormous budget deficit and they feel that they are in no position to take care of themselves if their current benefits are cut. That is one reason why the sentiments that "government is getting too big" and "don't cut my Medicare" tend to go together. It isn't merely hypocrisy. Older people have built their lives around certain government guarantees and many are not in a position to make major adjustments now. There will be no new savings and investment to make up for Social Security cuts. Whatever benefits might come from voucherizing Medicare will come too slowly to help off-set cuts in reimbursements.
The question is not how we will take care of those who are already too old to work. The question is what adjustments will be made for middle-aged and younger people. One choice we do not have is keeping the existing system for younger workers at the current tax burden. That isn't going to happen no matter who wins what election.
There are false and comfortable choices that only promise sacrifice for someone else. Obama says that "if you like your health care plan, you can keep it" and "no tax increases if you make less than $200,000." John Boehner says "extend the Bush tax cuts, and repeal Obamacare and...uh...I'll get back to you." These kinds of misleading tactics are designed to disguise either long-term policy goals (Obama) or get through one election cycle without having to say anything real about the problems we can't escape (Boehner.) You won't find our actual policy future in either man's rhetoric.
While there are many intermediate options (and innumerable details), our policy options fall somewhere between two poles, and reality will probably end up much closer to one than the other. The real challenge of statesmanship (as opposed to merely grasping for a chairman's gavel) will be to influence policy making between those two poles.
1. The first might be called the Bernie Sanders/Nancy Pelosi pole. People would pay higher taxes during their working years in order to finance the full Social Security benefit for currently young and middle-aged high earners. There will be centralized government control over health care. The wealthy will still be able to pay for their own care but the vast majority of the public would get their health insurance through the government and have no other realistic options. Medical providers would be oriented around providing (or not providing) the services that the payer (the government) wanted provided. Individual middle-class consumers would be marginal and have no bargaining power with medical providers. The vast majority of people would get the health care that government decided to pay for.
2. This second might be called the Mitch Daniels/Paul Ryan pole. Higher earners would get somewhat less from Social Security when they retired. That means more saving and investing now. Some large fraction of workers in physically less demanding jobs (and who had not developed crippling injuries or conditions) would have to retire later. In return, we will all pay lower taxes during our working lives. Most people would pay for most (this part is negotiable) of their routine health care costs out of pocket or out of Health Savings Accounts. The government or private insurers would cover catastrophic health care costs. That means that individuals would have to choose which health care providers provided the best services at the lowest price. In return, they would get lower costs for many services, lower premiums, and higher take-home pay.
Both poles (and every real world-oriented plan in between) involve sacrifices by lots of somebodies, but none involve cutting off people who are retired or near retirement. It also means that older people who sense that government's current promises are unsustainable in the long-term are wiser than smug and malicious creeps who can't understand why people in Medicare-provided scooters don't support creating an expensive new middle-class entitlement.