In The News
International News
Medicare Review
Medical Gluttony
Medical Myths
Overheard in the Lounge
Voices of Medicine
Book Reviews
Hippocrates and His Kin
Related Organizations
Archives

AAPSJPANDS
World Congress     National Association of Health Underwriters
Semmelweis Society

HealthCare Communication Network          HealthPlan USA
Del Meyer, MD Website

  

Community For Better Health Care

Medicare Review
Current Issue:                                         (previous issue)     (past issue)

Social Security and Medicare Projections: 2008, by Pamela Villarreal, NCPA

The 2008 Social Security and Medicare Trustees Reports show the combined unfunded liability of these two programs has reached $101.7 trillion in today's dollars! That is more than seven times the size of the U.S. economy and 10 times the size of the outstanding national debt. The unfunded liability is the difference between the benefits that have been promised to retirees and what will be collected in dedicated taxes and Medicare premiums. Last year alone, the size of the debt rose by $11.5 trillion. If no other reform is enacted, this funding gap can only be closed in future years by substantial tax increases, large benefit cuts or both.

Social Security versus Medicare. Social Security's projected deficit receives the bulk of attention from politicians and the media, but Medicare's future liabilities are far more ominous. The numbers in the nearby table are especially interesting in light of President Bush's efforts to reform Social Security. Note that:

  • Medicare's total unfunded liability is more than five times larger than that of Social Security.

  • Further, the Bush administration's newly added prescription drug benefit (Part D) has an unfunded liability greater than Social Security!

Future Payroll Tax Burdens. Currently, Social Security and Medicare Part A (Hospital Insurance) benefits are funded by a 15.3 percent payroll tax on wages  -  12.4 percent for Social Security and 2.9 percent for Medicare. But if payroll tax rates rise to meet unfunded obligations:

  • When today's college students reach retirement, Social Security alone will require a payroll tax of 16.55 percent, one-third greater than today's rate.

  • When Medicare Part A (hospital insurance) is included, the payroll tax burden will rise to 25.25 percent  -  more than one of every four dollars workers will earn that year.

  • If Medicare Parts B and D are included, the burden of Social Security and all of Medicare will climb to 33.6 percent of payroll by 2054  -  one in three dollars of taxable payroll, and twice the size of today's payroll tax burden!

  • Thus, one-third of the wages workers will earn in 2054 will need to be committed to pay benefits promised under current law. That is before any bridges or highways are built and before any teachers' or police officers' salaries are paid. . .

Impact on Federal Revenues. Total health care spending in the United States has historically grown 2.5 percentage points faster than per capita Gross Domestic Product (GDP). In particular, Medicare spending may rise even faster than the Trustees report estimates. According to the Congressional Budget Office (CBO), if Medicare spending continues to grow at the historical growth rate of total health care spending:

  • Social Security, Medicare and Medicaid (the health care program for the poor) will consume nearly the entire federal budget by 2050.

  • By 2082 Medicare spending alone will consume nearly the entire federal budget.

Can Higher Taxes Solve the Problem? The CBO also found that if federal income tax rates are adjusted to allow the government to continue its current level of activity and balance the budget:

  • The lowest marginal tax bracket of 10 percent would have to rise to 26 percent.

  • The 25 percent marginal tax bracket would increase to 66 percent.

  • The current highest marginal tax bracket (35 percent) would have to rise to 92 percent!

Additionally, the top corporate income tax rate of 35 percent would have to increase to 92 percent.

Pay-As-You-Go. Social Security and Medicare are in trouble precisely because they are based on pay-as-you-go financing. Every dollar of payroll taxes is spent. Nothing is saved, and nothing is invested. The payroll taxes contributed by today's workers pay the benefits of today's retirees. However, when today's workers retire, their benefits will be paid only if the next generation of workers agrees to pay even higher taxes.

What about the Trust Funds? Like other government trust funds (highway, unemployment insurance and so forth), the Social Security and Medicare Trust Funds exist purely for accounting purposes: to keep track of surpluses and deficits in the inflow and outflow of money. The accumulated Social Security surplus actually consists of paper certificates (non-negotiable bonds) kept in a filing cabinet in a government office in West Virginia. These bonds cannot be sold on Wall Street or to foreign investors. They can only be returned to the Treasury. In essence, they are little more than IOUs the government writes to itself.

Every payroll tax check signed by employers is written to the U.S. Treasury. Every Social Security benefit check comes from the U.S. Treasury. The trust funds neither receive money nor disburse it. Moreover, every asset of the trust funds is a liability of the Treasury. Summing over all three agencies (both trust funds and the Treasury), the balance is zero. For the Treasury to write a Social Security check, the government must first tax or borrow.

Conclusion. The Social Security and Medicare deficits are on a course to engulf the entire federal budget. If our policymakers wait to address these growing debts until they are out of control, the solutions will be drastic and painful.

To review the graphs and read the entire report, go to www.ncpa.org/pub/ba/ba616/.

 Government is not the solution to our problems, government is the problem.

- Ronald Reagan

subscribe


Previous Issue:                                         (current issue)     (past issue)

The Economics of Entitlements

Horrors of a 'Crisis' By George F. Will, Washington Post, Sunday, April 13, 2008

During presidential elections, when candidates postulate this or that "crisis" for which each is the indispensable and sufficient cure, economic hypochondria is encouraged, so a sense of suffering is rampant. Recently the Wall Street Journal, like Joseph Conrad contemplating the Congo, surveyed today's economic jungle and cried, "The horror! The horror!"

Declines in housing values and the stock market are causing some Americans to delay retirement. A Kansas City man had been eager to retire to Arizona, but now, the Journal says, "figures he'll stay put for another couple of years." He is 59.

So, this is a facet of today's hydra-headed "crisis" -- the man must linger in the labor force until, say, 62. That is the earliest age at which a person can, and most recipients do, begin collecting Social Security.

The proportion of people aged 55 to 64 who are working rose 1.5 percentage points from April 2007 to February 2008, during which the percentage of working Americans older than 65 rose two-tenths of one percentage point. The Journal grimly reported, "The prospect of millions of grandparents toiling away in their golden years doesn't square with the American dream."

Oh? The idea that protracted golden years of idleness are a universal right is a delusion of recent vintage. Deranged by the entitlement mentality fostered by a metastasizing welfare state, Americans now have such low pain thresholds that suffering is defined as a slight delay in beginning a subsidized retirement often lasting one-third of the retiree's adult lifetime.

In 1935, when Congress enacted Social Security, protracted retirement was a luxury enjoyed by a tiny sliver of the population. Back then, Congress did its arithmetic ruthlessly: When it set the retirement age at 65, the life expectancy of an adult American male was 65. If in 1935 Congress had indexed the retirement age to life expectancy, today's retirement age would be 75. . .

Yes, in January single-family homes in major metropolitan areas lost 10.7 percent of their value from last January. To find such a large decline in a year you must peer back into the mists of prehistory, all the way back to . . . the 1990s. Furthermore, the vast majority of homeowners will remain well ahead, even after the market corrects for housing inflation.

By one measure, between the beginning of 2000 and the middle of 2006, as the consumer price index was rising 21 percent, average housing prices rose 93 percent -- and much more in some markets Miami, 180 percent; Los Angeles, 175 percent; Washington, D.C., 150 percent).

Not long ago there was broad agreement that too much of Americans' wealth was tied up in the nation's housing stock and that the principal impediment to homeownership was not a scarcity of cheap mortgages but the prevalence of high housing prices. Hence deflation of housing prices would be desirable. . .

Subprime mortgages are a small minority of mortgages, and only a minority of subprime borrowers are not making their payments. Casting this minority of a minority as victims of "predatory" lending fits the liberal narrative that most Americans are victims of this or that sinister elite or impersonal force and are not competent to cope with life's complexities without government supervision. . .

What next? Adults still burdened with student loans have not yet announced their entitlement to relief, but as they watch this subprime drama, they might.

To read the entire OpEd column, go to

www.washingtonpost.com/wp-dyn/content/article/2008/04/11/AR2008041103250_pf.html or

www.sacbee.com/debate/v-print/story/856123.html

georgewill@washpost.com

 Government is not the solution to our problems, government is the problem.

- Ronald Reagan


Past Issue:                                         (current issue)     (previous issue)

Does Medicare Change the Benefit-Risk Equation?

Hospital and Surgical Errors or are they Just Poor Outcomes?

Sacramento had a recent case of post-op, drug-resistant hip infection at one of the local hospitals. There was a lot of unhappiness and resentment against the surgeon and the hospital. The investigation indicated that all the sterile protocols were completed as outlined. Mistakes, errors and sometimes poor outcomes just happen. But does anyone go back to the decision-making process? Was this hip replacement really needed? If it wasn't free with taxpayers' moneys such as Medicare, would the patient have had it done?

Most patients expect perfect outcomes despite a list of possible bad results that they read, sign, and don't believe will ever happen to them. What would put this in perspective? A percentage co-payment. If a patient had to pay even 10 percent of the hospital bill of, say $20,000, everything would be in perspective. "Is the pain and suffering I'm experiencing worth the $2,000 I'll be paying for this operation?" When I phrase it this way to patients asking the question, I'm always surprised at the number that state the pain and suffering is not really that severe and really doesn't interfere with activities significantly enough to warrant the expense. "I'll wait a few years." At that time, the risks and cost vs benefit ratio may be entirely different and the operation can proceed with an entirely new perspective. An adverse outcome will become acceptable considering the pain and suffering at that time.

With government medicine, there is no benefit-risk ratio that reaches the level of consciousness. Everyone expects a perfect outcome. It they are advised to have a surgical procedure, they assume that is the only option. It is all benefit and the risks are a fairy tale. The risks are written down, in their estimation, because some government agency tells doctors and hospitals it must be done. "It doesn't apply to me." Only when they have a stake in the procedure, not a fixed dollar co-payment, but a percentage co-payment which forces them to have a stake in the action from start to finish, will appropriate benefit-risks be understood. It will never happen in universal health care. That's why health care costs escalated with Medicare, Medicaid, Government sponsored HMOs, and will skyrocket with Universal health insurance which will then ration care.

 Government is not the solution to our problems, government is the problem.

- Ronald Reagan

top


For other issues, please visit our archives.

We invite you to sign up for this biweekly newsletter.





Terms Privacy
All rights reserved ©2007 Medical Tuesday.Net