In the real world, what happens if you’re given less money to cover people with and more flexbility about what to do with it what you’re going to do is simply cover fewer people. In particular, care for the elderly and disabled are likely to get hammered over the long-term thanks to productivity issues. Medical technology does advance and that sometimes leads to great new things—pills that treat illnessness, machines that help us test for disease—but the foundation of long-term care for the elderly and the disabled is human attention. People who need help caring for themselves on a day-to-day basis need help from other human beings. If you take the main public program for financing that kind of care and insist on its budget shrinking as a share of GDP, then the people who need help are out of luck. As economy-wide productivity rises, it’ll get harder and harder to “afford” programs that provide labor intensive care even in the real world society will be richer than ever

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