Tuesday, May 10, 2011
Health Care Boehner's latest boner: Means-testing Medicare
Posted by Max Brantley on Tue, May 10, 2011 at 8:46 AM
House Speaker John Boehner proposes means-testing Medicare. This would, in time, kill it. The same for means-testing Social Security, another popular idea among Republicans and other 'baggers. The notion that all pay and all receive is the bedrock of the programs' popularity. Writes Talking Points Memo:
Under the plan in the GOP budget, beneficiaries would get means-tested subsidies to buy private insurance. But those subsidies would shrink relative to the cost of health care over time, and soon prove inadequate. Here Boehner is endorsing the concept of means testing, whether applied to Medicare as it exists right now, or privatized Medicare."For those who have substantial means, you can pay your own premium," he added.
That's still a controversial position particularly given the relatively modest savings. In essence it would mean requiring a wealthier subset of seniors to pay thousands-more dollars a year out of pocket, after they paid their whole lives into a program meant to significantly limit their costs. And to an extent, it cuts against the basic compact of entitlements — that by treating wealthy and poor beneficiaries equally, the programs win much broader buy-in from the public, which protects them from the sorts of political attacks that make welfare programs so vulnerable.
Bottom line: Republicans want these safety net programs to go away. Those who can afford to live without them will be fine. Those that can't ... tough. They should have worked harder and smarter or been born with a silver spoon.
Speaking of...
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Obamacare saves seniors billions in drug costs
May 1, 2012Another inconvenient fact about Obamacare: In the first two years after “Obamacare” was signed, Medicare reforms in the law saved seniors a total of $3.4 billion in prescription drug costs by bridging a coverage gap, according to official figures. /more/
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Comments (22)
Showing 1-22 of 22
Whether it’s Medicare, Medicaid, or the debt ceiling, give Boehner and his buds enough time and they’ll hang themselves. I’m lovin’ it.
like
dislikeSo, what is your solution? I guess we'll keep doing nothing and let our kids worry about it.
Or we can let at least some of the Bush tax cuts expire, reduce the size of the military and our overseas commitments, and, yes, spend less on Medicare and Social Security by means testing and by raising the retirement age for future recipients who are now in their 50s and below.
Just being mad at one political party or the other isn't going to solve the problems. Especially if we don't want to admit the problems exist.
Past time to put the lie to Voodoo economics. They've had a good run, it's time to push the talking points. Reagan was boob, simply the first crafty salesman for the uber rich.
Steve,
A lot of what you write makes sense. Means-testing social programs doesn't. Raising retirement age on a sliding scale? Sure. Taking the income cap off contributions? Sure. Looking for ways to better manage health care costs? Absolutely. My first suggestion is to make Medicare a universal coverage program. I remind you that every western world country provides universal care and longer life expectancy for much less per capita than we spend on health care.
Just put the money back into Medicare and SS that has been borrowed over the decades - plus interest - cut waste in the program not just the program.
But, to address Boehner's suggesting:
Those that are wealthy enough in their later years will not get a government subsidy for their health care costs?
Will the wealthy still be making payroll contributions to medicare such that those who don't have enough wealth in their later years can benefit from a solvent system in their later years?
What if I planned on making it big on my own and was expecting not to need socialized medical care in my later years? Could I opt out of contributing through taxes on my payroll?
What if my "make it big" plans failed and I had nothing for health care expenses in my later years? Too bad for me, and I die without health care? Or do I tax the Emergency rooms which falls back on society anyway?
Is that smart to allow people to opt out? If enough people don't pay into the system it can't be solvent. So it would die which is what the GOP wants and hopes for.
No, put the money back into Medicare and SS that has been borrowed over the decades - plus interest - cut waste in the program not just the program.
Max, thanks for responding. I don't think working families, or the country, can afford to continue to pay most of the medical bills for the wealthiest of senior citizens without there being some sliding scale, but I would give it up in exchange for all of your suggestions except the last one. Compromise is not a bad thing, and it would be better than what we have, which is stasis.
I just wish the tone of the debate would allow us to actually address these long-term issues. Instead, we have a clear pattern: One party sticks their toe out on something controversial, and BAM! - the other side makes a political decision to oppose it sight unseen and gets rewarded at the polls. It happened with President Bush and Social Security. It happened with President Obama and health care. (Notice my use of the honorific "President" in front of both. Just a thing I have.) And now it is happening on Medicare. I don't agree with the Ryan plan and have said so in print, but at least it's a start, and if the Democrats would counter instead of gleefully licking their chops, then maybe we could get somewhere.
Ron, all must contribute... If anything all should automatically be 'opted' in whether they use it or nay.
Dems just spent nearly a trillion bucks to supposedly slow the rise in the highest health care costs in the world, years out there. A dubious claim. Considering Dems did this by assuring subsidy money to profiteers, by providing profiteers millions of new customers at whatever they want to charge... the kabuki here is really pathetic... the results will be largely the same. Dems gave GOPers nearly everything they wanted from 90's into early oughts... it would be stupid to assume Dems wont give GOpers what they want now, in a few years time... just as soon a the GOPer talking points become 'normal', like talk of torture is now 'normal' in the zeitgeist.
Until more than a handful of elected politicians demand single payer or tri care for all... both criminal parties will be responsible for making us all pay into a corrupt system which we know will kill as many people as 9-11 every 3ish weeks... without end.
get out of the criminal money party lock box.
Gotta cut something. A lot of something.
http://en.wikipedia.org/wiki/File:GAO_Slid…
“ . . . cut waste in the program not just the program.”
No kidding. It's a nightmare.
The Obama administration says Medicare “overpayments” (anything from a billing error to a flagrant scam) totaled $36 BILLION in 2009. Getting this nonsense under control could help immensely in paying for the existing healthcare reform program, and eventually “Medicare for All.”
Cleaning up fraud and waste is a high Obama priority. If he asked me (which he won’t) I’d say start by ending Medicare’s current “pay-and-chase” system in which docs, hospitals, and other providers are paid first and questions are asked later if at all.
The current payment methodology is a tried and proven recipe for disaster, imo.
When talking about fraud in medicaid/medicare it is important to make the distinction that largely fraud is committed upon uncle sam. Uncle Sam is a victim of fraud for the most part... with private insurance and big pharma... they are models which are inherently the perpetration of fraud. Profit is king, not actual health care.
Medicaid and Medicare budgets are about 800b per year. 36 billion is practically chump change in comparison to the looting of our entire system by private insurance and big pharma. Waste and fraud under uncle sam pales in comparison... reductions in fraud will best be achieved when they quit paying attention to privateers manipulation of billing systems and when uncle sam quits subsidizing them in any manner.
Republicans means-testing Medicare? The world is upside down. That's a "progressive" class-warfare solution. Medicare is paid by all. And, by the way, unlike Social Security the Medicare tax is not capped by income.
I can't buy single payer. Working-age citizens can adjust their circumstances through seeking new jobs, moving to better economies (leaving Detroit), getting more eduction to better their income, etc. The market must have the inherent motivations all these require. But retirees have much more limited options (other than WalMart greeter). Perhaps the minimum age for Medicare also needs to move up to account for at least some of the probably 10-year increase in life span since it was introduced. But means testing is anathema to the entire concept behind Medicare (and would be a huge breach of faith with all those who have paid in).
End the funding of the wars. Bring our troops home. Don't get into another war. Saves about $120 Billion a year. Leave Tri-Care alone.
Stop spending money on cold-war weapon systems (dropping F-35 saves 3.5 billion, MV-22 Osprey-dropping 100 saves $6.7 Billion, Expeditionary Fighting Vehicle, saves $15 billion)
Reduce the fleet size of the Navy.
Reduce the number of Air Force squadrons.
Allow Bush tax cuts to expire but extend marriage relief, credits, and incentives for children, families, and education.
Current top tax rate is 35% at $380K+. Institute Schakowsky millionaire tax rates: couples
$1M to $10M 45%
$10M to $20M 46%
$20M to $100M 47%
$100M to $1B 48%
$1B+ 49%
Sander's Estate Tax generates about $34B/yr:
$3.5 Million exemption from the estate tax
45% on taxable portion of estates up to $50M
55% on...up to $500M
65% on...over $500M
Tax capital gains and dividends as ordinary income, like I get taxed when I work. Dividends are currently taxed at 15%
Cap the benefit on itemized deductions at 28% so that there's not as much tax benefit on mortgage interest.
Index the Alternative Minimum Tax to inflation to help middle class taxpayers.
Replace the tax exclusion on state and local bonds and let the government give them a 15% subsidy of the interest that is paid.
Tax US corporate foreign income as it is earned instead of when the money comes back here. That encourages them to bring the money back here and create jobs here instead of abroad.
Repeal the preferential tax treatment of oil/gas/coal royalties, repeal tax credits for oil/gas/coal exploration.
Reinstate the Superfund excise taxes that were eliminated in 1995 so that general revenues aren't used and appropriated on a year to year basis for hazardous cleanup.
Add a tax on credit default swaps, both sides of futures and forwards, option premiums, and foreign exchange spot transactions. It's a tax on the manipulators/speculators that caused our financial crisis.
Enact a financial crisis responsibility fee of .15% of the covered liabilities of banks that have more than $50B in assets.
Make corporations that notoriously dodge taxes pay up.
Raise Social Security taxable maximum to 90% of earnings on the employee side and eliminate the taxable maximum on the employer side.
Make more jobs created by investing in education, clean energy, rebuilding infrastructure/highways/bridges/waterways, research/development, broadband infrastructure.
Enact a public option.
Negotiate Rx payments with pharmaceutical companies. Prevent a cut in Medicare physiccian payments for now.
All of this is in the People's Budget. It's ok. The wealthy will still be doing just fine.
Theo, you are assuming an awful lot with this statement.
"Working-age citizens can adjust their circumstances through seeking new jobs, moving to better economies (leaving Detroit), getting more eduction to better their income, etc. "
For vast numbers of working-age citizens, it just isn't true. Come down out of your ivory tower and join the real world.
outlier,
theo is theoretically correct in that the young do have options that the elderly do not. That is reflected in the nest egg strategy of investing.
The young can be more agressive in risk since they do have the ability lose all their principal and then start over.
The elderly do not have the same options because the point where the elderly CAN NOT keep working, even as a greeter, is closer at hand on average.
Citizen1, you are making the same assumptions that Theo does. Every young working person is not free to pull up stakes and move. You ignore those who may have family obligations (elderly parents, perhaps?). Every young person may not be able to get more education. You assume that everyone is capable of becoming a mechanical engineer. You ignore the fact that a large percentage of the rural and urban working poor are "surplus" to society. There aren't good jobs for them no matter if they move, get more education or whatever.
Imjuztsaying, add:
no government contracts for companies who supply goods made overseas. If you want a government contract, then make sure you have the capability to perform the service on the mainland US soil (not the Marshall Islands or Guam) and manufacture or make the product here. Sourcing issues-That's your problem, not the government'.
No tax deductions for corporations on that percentage of income earned overseas.
No company that doesn't pay US corprate taxes shall get any contract for any product or service.
outlier, by your logic we just take on everyone for everything. We can't afford that. You have a historically weak definition of "not free to". Think all those folks who left the Potato Famine on ships for America didn't leave some family? And leave them a lot farther away than a Greyhound bus ride? I assume all the folks streaming in from Mexico have more options than poor US citizens?
I'm not in an ivory tower. If the economy of this country collapses a lot more folks will wish they have half of what we used to provide. But our moral obligation is to take care of those who can't care for themselves, not those who find it tough to care for themselves. The simple fact is that we will go bankrupt following your logic.
>>Whether it’s Medicare, Medicaid, or the debt ceiling, give Boehner and his buds enough time and they’ll hang themselves. I’m lovin’ it.<<
Oh, sing the song children. I'm lovin watching my old Medicare Republicans across the street look at me in disbelief. I warned them before they voted last year what the devilish, dishonest party was up to then I reminded them a week or two ago...total disgust. Now, they would vote for anyone other than Boss Womack the second time around.
Privatizing Social Security worked so well. Get on Durango's bandwagon and encourage, encourage, encourage Republicans to support this POS.
Taking it back in 2012.
The Republican Party of Koch has had its final run for awhile. It's been a trip watching the gawdy T'baggers perform but the act is now old hat and we need to get to the bidness of making America work for all of us.
It is a myth that hard work and education lead to a higher quality of life.
Statistically -- ignoring political theory in favor of cold hard facts -- if you are born poor in the U.S., the most likely outcome is that you will live poor, you will die poor and your children will be poor.
There is no other option when 15% of the people control 85% of the wealth. It is very hard to move into that 15% when the people who are there don't want to leave and control all the capital.
The most favorable thing you can do for yourself if you want to move upward economically is to move to a different country where mathematically there are greater odds of upward mobility.
Interesting, Theo, that you chose the Great Famine as an example. One million people died in Ireland, and one million immigrated. Here is Bigelow's take on what happened from "Let There Be Markets: The Evangelical Roots of Economics". You would have been quite at home with the political and economic thinking of Victorian England.
"Victorian evangelicals took a similar approach to the crisis in Ireland between 1845 and 1850—the Great Hunger, what came to he known as the potato famine. In office at the time of the first reports of starvation, the Tory administration of Robert Peel responded with a program of food supports, importing yellow cornmeal from the United States and selling it cheaply to wholesalers. Corn was an unfamiliar grain in Ireland, but it provided a cheap food source. In 1846, however, a Whig government headed by Lord Russell succeeded Peel and quickly dismantled the relief program. Russell and most of his central staff were fervent evangelicals, and they regarded the cornmeal program as an artificial intervention into the free market. Charles Trevelyan, assistant secretary of the treasury, called the program a "monstrous centralization" and argued that it would simply perpetuate the problems of the Irish poor. Trevelyan viewed the potato-dependent economy as the result of Irish backwardness and self-indulgence. This crisis seemed to offer the opportunity for the Irish to atone. With Russell's backing, Trevelyan stopped the supply of food. He argued that the fear of starvation would ultimately be useful in modernizing Irish agriculture: it would force the poor off land that could no longer support them. The cheap labor they would provide in towns and cities would stimulate manufacturing, and the now depopulated countryside could be used for more profitable cattle farming. He wrote that his plan would "stimulate the industry of the people" and "augment the productive powers of the soil."
Are we all to be reduced to Oliver Twist saying, "Please Sir, may I have another?" That is where the unfettered markets you and many glorify will lead.
lier, we are so far from Dicken's unfettered markets that you couldn't get there on the last space shuttle flight. (BTW, I'm not sure debtors' prison really represents an unfettered market either.) The simple truth is still this: in the end all we can do is divide up raw production and we ultimately can create the greatest good by coming as close as we can to maximizing total production while spreading it as equitably as possible. History has proven over and over that trying control the inputs to and benefits of production simply stifles it all. And you can't get enough taxes to provide everything you want to provide. And if you tax me at 60% at some point I go live off the land and your programs. But when we're all living off the programs who will pay?
The fraud in Medicare is not fraud by the recipients of Medicare, but rather fraud by the providers of Medicare, yet the recipients are the ones who get the blame. Why don't we start blaming the doctors and the hospitals who are committing the fraud? I am on Medicare, and I recently had my annual physical examination. I passed, but only after undergoing several tests which I knew were unnecessary, but which my doctors ordered. Stop blaming the people who are on Medicare, and start looking into the rip-off artists who benefit.
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