Ben Bernanke gave testimony on increasing entitlement program costs today. There was one key point I wanted to discuss: Addressing the country's fiscal problems will take persistence and a willingness to make difficult choices. In the end, the fundamental decision that the Congress, the Administration, and the American people must confront is how large a share of the nation's economic resources to devote to federal government programs, including transfer programs such as Social Security, Medicare, and Medicaid. I think the most fundamental decision is different. This country needs to make a decision about how it wants to organize the social insurance system. Do we want the public/private hybrid we have now, or something more like the public/private hybrid that almost all other industrialized countries have? The foreign model tends to be much cheaper (not to mention more generous and inclusive). They're organized better. Social insurance in this country is really, really expensive. We should talk about how to organize ours better. Jacob Hacker's proposal gets us started in that direction. Why not talk about it as a way to keep down costs? We can fix this long-term fiscal imbalance, but it's going to take something that goes much deeper than the decision Bernanke claims is most fundamental. We need to reorganize, step by step, the way social insurance is provided in this country. It would be nice if Bernanke at least acknowledged that this was an option.