Thursday, December 30, 2010

How Would You Keep Medicare Afloat, Or Would You?

Medicare covers about 46 million elderly and disabled Americans at a cost of about $500 billion. It's straining to pay that bill. Unfortunately, costs continue to rise along with number of beneficiaries (as baby boomers retire).

President Johnson signed Medicare into existence in 1965 as an amendment to the Social Security Act. It's a single-payer system covering about 80% of a patient's costs.

If you had to choose one method to keep Medicare afloat financially, which would it be?


Sara said...

Expand medicare to cover everyone. Healthcare problem solved.

Tschäff said...

None of the above. The problem stems from medical costs rising faster than wages every year. We need to address the causes of our uniquely inefficient system to get better outcomes and lower costs. It can be done, other countries have done it. A lot of work has been done in this area by Michael Porter.

Bix said...

I think something has to happen and I think that something will be raising the payroll tax from 2.9% to something closer to 4%. But it won't happen until after the 2012 presidential election.

It's likely the eligibility age will go up, as it has for Social Security ... from 65 to 67. But, again, that won't happen in my opinion, while Obama is in office.

I think the thing most likely to happen is an eroding of coverage. Medicare will pay less and retirees will pay more, if they can. It's happening with private insurance, it will happen with Medicare.

Maybe reducing the benefit in this way is a form of managing costs but I'd rather see the price for services drop.

Tschäff said...

There is also the problem that most people think the US federal government can become insolvent, thus fear the national debt. The truth is the US federal government never is at risk of involuntary insolvency, and the federal debt is equal to non-government savings to the penny. The way our monetary system operates however isn't taught to most the population, and many politicians have a vested interest in getting the public to believe the nation is bankrupt to achieve certain political goals.

I made this video to explain debt and deficits as simply as possible.

The problem we face with Medicare (and all American health care) is that it takes up an ever increasing share of our total material economic resources, and those are limited.

Bix said...

When I said eroding of coverage was most likely to happen, I meant it was most imminent ... not that it was the only thing that will kick in.

"better outcomes at lower costs" Can't agree with that more, Tschaff. But how? Already: Plan To Cut Deficit Would Sock Seniors On Medicare. We need people like you to run for office.

Tschäff said...

My economist friend came up with these nifty ideas:

I would add there are a bunch more ways, like setting up a reward fund for institution who come up with drugs we want. Instead of patenting the drugs, it is public domain, and the institution is awarded the large cash prize. Increased access to preventative care will lower costs and save lives. ICU staffing should be appropriate. Standardized best practices (see the book the Checklist Manifesto) has been proven to lower costs significantly by reducing hospital employee's mistakes. There should be universal standards for billing and medical records. Competition should be based on the level of specific diseases and conditions and be regional not local. We need more information about medical providers (experiences, outcomes, and prices). Tort needs to be reformed. A huge chunk of doctor's income goes straight to liability insurance.

We shouldn't fight wars that don't make sense. Not just for medical cost reasons.

Then there is the more controversial stuff. End of life care especially. As technology advances we're able to keep people alive with machines for longer and longer, but it is extraordinarily expensive and still increasing. The way we have it set up now is the decision to end or sustain life is up to the patient or their family. However the bill for this is distributed to everyone paying for insurance, ie society at large. We're close to the point where tradeoffs might need to be made like those in the original post vs allowing someone who is close to death to live a little (and in some cases a lot) longer. Since we can't do it all, it is a choice I think belongs to everyone who has a stake in the outcome.

There is a sea of good ideas out there. There isn't the political will to do hardly any of it though.

Anonymous said...

I think they need to put the medicare more affordable so that even the simple person can benefit this medicare program.