The problem of entitlements

Lost in all the detailed debates and partisan bickering about issues like health care is a much more fundamental issue which isn’t being debated at all: in a relatively wealthy nation such as ours, just what should citizens be “entitled” to from the government?

For example, in the field of health care, in our nation we can perhaps all agree that everyone ought to be entitled to basic first aid in an accident irrespective of their ability to pay. And most of us might agree that no one is “entitled” to cosmetic botox treatment or face lifts at the taxpayer’s expense. But where is the line between? Should everyone be “entitled” to knee replacements and hip replacements at taxpayer expense? Should a committed smoker be “entitled” to expensive lung surgery or treatment for lung cancer at taxpayer expense? Should an alcoholic be “entitled” to liver transplants at taxpayer expense?

In terms of finances, a wealthy nation ought not to have people so poor they are starving to death. But does that mean the poor should be “entitled” to prime steak at taxpayer expense? (not a meaningless question – people have been seen buying prime steak with food stamps) We ought not to have homeless people wandering the streets, but does that mean citizens should be “entitled” to have the taxpayers bail out mortgages they can’t pay? Even if they foolishly bought houses larger than they could afford? Unemployment benefits were originally supposed to bridge people over for a few weeks or at most a few months while they were between jobs, but now unemployment has been extended to 99 weeks. Just how long should our citizens be “entitled” to collect unemployment – years?

This question of entitlements is not separate from the issue of taxes and national debt. Entitlements cost money – enormous amounts of money in some cases (think Medicare, for example) - and ultimately involve taxing people and companies to pay for them (even if that taxation is temporarily delayed by deficit spending and government borrowing). That necessary taxation can represent a significant drag on the economy. The difficult issue is finding the balance between providing citizens reasonable “entitlements” and keeping the nation financially healthy.

I don’t have pat answers to these questions. Indeed, these are very hard questions, and deserve a long national debate. But this issue of just what our citizens should be “entitled” to is at the root of many of the current raucous political discussions.