Michael Hiltzik's column advanced the idea that deciding what government should do ought to be based on the overall savings to society. I agree, but there are complicating factors.
It's much easier to develop an estimate of the cost of the government action than the offsetting savings. New Jersey Gov. Chris Christie's estimate of the cost to develop the railroad tunnel was straightforward, but the positive impacts would have to be based on vague factors and speculation.
Furthermore, sometimes it's better to pay a higher price for a more satisfactory outcome. It would probably be cheaper in the near term, for example, for the government to take over all energy development and production, but this wouldn't spawn truly innovative energy solutions. The impacts of these not-yet-invented energy sources cannot be estimated, and thus it is in society's interest to maintain private enterprise in this realm (though better regulated).
Our folks in Washington would have us believe that "fixing" Social Security and Medicare will fix our problems. Changing Social Security won't fix our debt because it's a self-financed program, but both programs will soon represent major financial burdens. So let's make some changes in Medicare, which presents a more urgent problem.
The most meaningful change we can make without negatively impacting care is to change the entire program from fee-for-service into managed care. This way physicians would have access to all of the tests, medications and treatments of the patient and could administer better and less expensive care.
The sooner we move away from the government-run, single-payer plan that Medicare is today, the better off the country will be.