Adequate income is a social determinant of health. In the United States, only Social Security beneficiaries receive inflation-protected guaranteed income. Social Security needs another 1983 compromise in which stakeholders accepted “shared pain” to avoid insolvency. We propose indexing the benefit using the chained consumer price index (CPI) for all urban consumers and providing a one-time bonus of 8% to 10% for beneficiaries in their mid-80s, when needs become greater. The chained CPI has little impact when beneficiaries start receiving benefits, but older beneficiaries need protection. The estimated 75-year savings from this restructured benefit amount to 14.2% to 18% of Social Security deficits. Modest increases in payroll taxes and maximum earnings taxed should make up most of the shortfall. Including unearned income with wages and salaries subject to the 6.2% individual tax would produce much more revenue. The discussion explores the proposal’s political feasibility, grounding in current policy and political science literature, and the role of income as a social determinant of health.

The “new institutionalist revolution” in social sciences has led to a repositioning of social norms to the forefront of the pre-analytic vision in institutional theory and to the consolidation of the contextual analysis approach. That has significant epistemological, methodological, and political philosophy implications. This essay follows the logic of these developments showing: (a) why they inherently lead to the feasibility problem, the key of applied theory, toward which both contemporary philosophy and institutional analysis converge from different venues; (b) how feasibility is a nexus of empirical, counterfactual, normative, and contextual elements, that is, something more complex than a mere matching between empirical reality and institutional design; (c) what are the governance implications of all of the above, with an emphasis on an alternative approach (distinctive enough to circumvent both the conservative averseness to intervene and progressive drastic interventionism) and in which the public choice process is seen mainly as endogenized, socialized, and institutionalized, as opposed to formalized, intellectualized, and externalized.