Maggie's Farm

I would simply would change the tax law such that employer contributions to someone's medical insurance are a taxable benefit to the recipient just as cash compensation is.

A (perhaps THE) significant factor in inflated costs is that patients perceive (and in some cases, e.g. Medicare and Medicaid, actually are) that their insurance, and hence their medical care, is being paid for by someone else. Therefore, when their choices are "more money in their pocket" versus "more medical care (even if the benefits are minimal)", they have little or no incentive to choose the former as they don't recognize it as money in THEIR own pockets.

Oh yeah, if I ran the world, I would also ensure that the DSM is recognized for what it has become - an attempt by some in the mental health industry to force payments from insurance companies for life's ups and downs, life-style CHOICES (if you're fat because you lack self-control and eat a box of Krispy Kremes TID, I shouldn't be rehired to contribute to your coaching sessions), and minor foibles that are well within what would be expected in a bell curve distribution.

Sorry, but I needed to add the following......

The elephant in the room in regards to medical insurance is that "we" - as a nation - cannot afford to pay for everything for everybody. All health care policy analysts and politicians know this, but it's neither politically correct nor career enhancing for a politician to address either what this means or how it must be dealt with.

The elderly, particularly in their final year (or months), consume an overwhelming proportion of the medical care delivered in the US in dollar terms. Yet, they underpay for this.

Unlike private insurance policy premiums, Medicare premiums don't cover the costs of the care received by Medicare beneficiaries. The balance is paid for by (a) current taxes paid by current taxpayers, and (b) cost shifting, i.e. higher insurance premiums paid by, well, current taxpayers. With longer life spans and changing demographics (the aging of the boomers), the current situation is unsustainable.

The politicians and policy experts recognize that paying for medical care for the elderly involves making the working age pay the tab. They also recognize that there are limits to which this will be tolerated.

There are essentially two options to reduce the amount of money spent on this expensive end of life care for the elderly - or, put bluntly, to reduce the amount of medical care received by the elderly:

(a) Change Medicare as we know it to a means tested system that essentially provides charity medical insurance to the elderly poor - the working class will still pay for the poor elderly's medical care, but by eliminating the non-poor elderly, the tab will be "manageable". The non-poor elderly would purchase medical insurance in the private market - this would necessarily mean much higher premiums. The sheer number of non-poor seniors who would thus be "deprived" of their entitlement makes this a political non-starter. The notion that we would only be allowing people to live if they are rich enough to afford it would be appalling to the left - even though we only "allow" the rich other benefits and luxuries.

(b) Rather than limit people's choice to extend their lives based on their ability and willingness to pay for this expensive care, we can simply limit that choice based on their age - that's Zeke Emanual's concept that is incorporated into ObamaCare - and deny coverage (and eventually the service itself) for certain high cost treatments for anyone above a certain age. The government term is that such care is not "cost effective." The leftists see this a fair because the government rather than the free market gets to make the voice of who lives and who dies and this is supposedly more palatable to their supporters - "we're not going to let you die because you are poor, but because you are old."

When Sarah Palin spoke about the death panels under Obamacare, she was exactly right. The left wing media tried to brand her a fool and discredit her, but the death panels or independent payment advisory board are an ESSENTIAL feature of Obamacare that gives us option b. It is important to recognize that it won't just be the elderly with some terminal illness who are affected. The concept is that if the care costs more than what the government determines your productivity to society to be, it is nor cost effective and thus it is not unreasonable to deny payment across the board for such treatments. This could include children with certain diseases for which the treatment is expensive and a return to a "productive" life is unlikely.

Extending health care to more people is NOT a concern of the government, but ObamaCare does not do that. ObamaCare attempts to extend heath care INSURANCE to more people. Health care insurance is different that health care. Why should government decide that people must have health care or health care insurance or any other good or service that is produced by someone else. When government insists that Jones MUST have something that is produced by Smith, it sets the stage for robbing prom Peter to pay Paul.

Today's Medicare population may have paid something into the system, but far less that what is required to cover the cost of their premiums. Consider an 85 year old Medicare patient. Because Medicare didn't even begin until the mid 60's, they could not have even started contributing to the system unit their mid thirties. Furhermore, because they were paying (for the then current beneficiaries) based on costs from that time period rather than today's costs, they paid in a trivial amount.

Your post is a prime example of my point that seniors make it impossible to fix the entitlement problem that is unsustainable and killing America. Seniors are under the misconception that they have paid in an amount that justifies the benefits they now demand. This is not the case. These entitlement programs were enacted by the leftists to buy votes and expand government. The concern was not whether they were legitimate functions of government nor whether they would be sustainable when those politicians' careers was long past.

When seniors bitch that they want their premiums back if they can't have their entitlement benefits because of means testing, etc. what they are saying in effect is, "We don't want to pay the price for the liberals mistake, we want our grandchildren to pay that price." Newsflash - your generation elected the idiots who enacted these programs and your generation has allowed the government to continue and expand these programs for decades. Medicare was enacted just as you turned 21 and were able to vote. You're far more responsible for this mess than your grandkids!

You've missed the point I think we agree on virtually everything. It's just the issue of who pays for what has already been promised and in some cases delivered. I don't like it either and I recognize that because many who have already received the benefits that you, I and many other have paid for are either dead or dying or destitute, it's unlikely that we can force them to pay for the benefits they consumed. Thus, we're left with the question of who gets screwed.

Like you, I would also scrap all of the entitlement programs - Medicare, Medicaid and Social Security, along with food stamps, earned income tax credit, etc. In fact, I would abolish the income tax - what you tax, you get less of - and replace it with something like excise and property taxes.

My point was that most politicians recognize that these programs are not sustainable. However, as your comments regarding "I've paid into the system and therefore I want my money back either as a refund or as benefits" indicate, current beneficiaries don't want to be the ones who pay the price for poorly conceived entitlement programs that they helped enact. What is clear however is that eventually someone gets royally screwed. Is it fair that those of us who have carried the weight - that is those of us who have really paid the taxes - have to pay again? Nope! But it's foolish to imagine that there will be no eventual loser in this Ponzi scheme. The longer it goes on, the greater is the amount of wealth transfer and the greater is the amount of damage to the eventual patsies.

I think Paul Ryan's suggestions were a genuine effort to recognize the problem and to spread the pain over more people. Naturally, the leftists, who use these entitlement programs to buy votes, seized the opportunity to use the for political gain rather than trying to solve the problem.

I agree that in dollar terms the fraud issue is huge, but as a percentage of the budget it's trivial compared to the programs themselves. The solution is not to fix the problems with the entitlement programs - as long as we have government doling out money, there will be bad people taking advantage of it - the solution is to eliminate the entitlement program.

If we look at the federal budget from a broad perspective, we see that the entitlement programs (Medicare, Medicaid and Social Security) and military spending encompass the lion's share of the costs. The ONLY one that is a legitimate government function is the military. Eliminating the entitlement programs and approaching war as war (inflicting the maximum amount of damage on the enemy in the minimum amount of time in order to effect a rapid surrender rather than engaging in these prolonged forays in foreign lands) would solve our budget crisis and allow for a reduction in tax rates.

PS - In regards to your comment that the government owes you something for your SS/Medicare contributions because of the "contract", the SCOTUS ruled in 1960 (Flemming v Nestor) that entitlement to Social Security was not a contractual right.

PPS - I don't necessarily agree with the idea of means testing either. It is repulsive to me as I recognize it as simply one more form of wealth redistribution (socialism) from those who produced and saved to those who didn't. I mention it because of the issues I raised regarding (1) politicians worrying about the senior voting block, and (2) the reluctance of people, like you, to not get the benefits they "think" they paid for.