Of course the call for means tested programs extends well beyond our current debates over health care. Over the past few years we have be urged to save Social Security by paying benefits only to poor people and - until the Republicans became defenders of Medicare six months ago - we heard proposals to stop paying Medicare benefits to people who "didn't really need them."

The general argument is this: Why should we tax the entire population - some portion of which is not very well off - in order to pay pensions or other benefits to another group - some portion of whom may be well off. If we "target" pensions and benefits to those who really need them we will save money which we can use to reduce taxes.

Wonks Anonymous will pause to note that the tax reductions usually proposed are tilted heavily to the better off taxpayers. Let this pass for now.

Of course means testing requires the creation of a vast bureaucracy and lots of interesting and complex forms. Wonks Anonymous hopes that at least some of his readers are young enough to remember the FAFSA and other fun financial aid applications. Wonks Anonymous prays that most of his readers have never had to fill out an application for welfare.

But all of this paperwork and administrative effort is certainly worth it since it precisely measures needs and fairly allocates scarce resources to the most needy individuals in society.

So what would means tested health insurance, means tested Medicare and means tested Social Security look like?

We already have a means tested medical insurance program. My people call it Medicaid. This is the first program to be cut in bad times and the last to be increased in good times. One of the reasons we are discussing health reform right now is that Medicaid obviously fails to cover a great part of the working population that clearly needs help paying for health care.

As for means tested income supplements - the proposed replacement for Social Security - we have them. That would be Supplemental Security Income and General Assistance which we sometimes pretend provide a safety net for poor people who do not have children.

Programs that serve the needy have a hard time in this country. We have a moral aversion to poverty and a deeply rooted belief that it is a punishment of God upon the poor. And heaven forbid that they should be found taking our aid and indulging in an occasional round of beer and skittles.

When we add to this the fact that the poor are a minority it becomes almost impossible to sustain a decent level of support in any program that is targeted at the "needy". In some ideal world we might have a carefully crafted means tested program that really helped everyone who needed it. Not in this country and not in my lifetime.