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So when can I choose to opt out?


BurntOrange&White

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given the title, is this a real discussion on Medicare?

Chickens have come home to roost.  Medical costs are just too high and we won't take any real steps to lower them.  And/or we don't tax ourselves to cover the bill.   Old people get sick, and they burn thought more funds than they ever contributed as workers.  And one side-effect of getting well after being sick, is that you will most likely get sick again.    

Hasn't the Medicare payroll tax rate been the same since the early 80s?  The tax revenue only grows along with the rise in incomes?  Does anyone believe that healthcare costs have grown at the same rate as incomes?  Exactly we all know that isn't true.

(can we stop with the people that want to opt-out of paying taxes.  its a childish statement.  if we gave people the option to opt-out of any tax, 99% of the people will opt-out and 98% will still demand the benefit later.  have the courage to kill a program if we don't want it.)

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given the title, is this a real discussion on Medicare?
Chickens have come home to roost.  Medical costs are just too high and we won't take any real steps to lower them.  And/or we don't tax ourselves to cover the bill.   Old people get sick, and they burn thought more funds than they ever contributed as workers.  And one side-effect of getting well after being sick, is that you will most likely get sick again.    
Hasn't the Medicare payroll tax rate been the same since the early 80s?  The tax revenue only grows along with the rise in incomes?  Does anyone believe that healthcare costs have grown at the same rate as incomes?  Exactly we all know that isn't true.
(can we stop with the people that want to opt-out of paying taxes.  its a childish statement.  if we gave people the option to opt-out of any tax, 99% of the people will opt-out and 98% will still demand the benefit later.  have the courage to kill a program if we don't want it.)

Why continue to pay something that is failing and will fail? How are we going to bail it out? Something new should be setup to replace. Why should younger generations continue to pay for older generations when we won’t receive the same benefits?
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Just now, Bevo VIII said:


Why continue to pay something that is failing and will fail? How are we going to bail it out? Something new should be setup to replace. Why should younger generations continue to pay for older generations when we won’t receive the same benefits?

Ok.  But what do you want to do?  You can't just cancel it.  Old people either can't or most likely would struggle to pay their medical bills.  Is the answer to say tough, you screwed up being poor.  Or do you just want rich, older people to pay out of pocket.  I imagine they and their heirs won't be happy about that one.

When you say its failing, you should be clear that its failing financially.  Old people love Medicare and we have many, many people earning a living off that Medicare.   Healthcare is close to 20% of GDP.   Fair amount of that is based on Medicare.  

And of course, Medicare was temporarily saved from insolvency because of Obamacare as providers are now paid based on outcomes not just actions.  From my understanding a major factor behind the ACA was trying to save Medicare.  And it did as it pushed insolvency back another decade.  Another topic but its also why the GOP Congress doesn't really want a full repeal of the ACA when they understand the cost behind that move.

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13 minutes ago, Bevo VIII said:


Why continue to pay something that is failing and will fail? How are we going to bail it out? Something new should be setup to replace. Why should younger generations continue to pay for older generations when we won’t receive the same benefits?

Because neither system is going to fail. We will fix Medicare by raising contributions and, in the case of Social Security, eliminating the upper limit of income subject to FICA. 

In other words, your taxes are going to go up before anything ever happens to those programs.

 

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Just spit balling potential fixes here...

If you are already Medicare eligible, you will remain eligible for the FFS or MA benefits that you already receive.

Medicare is converted to a government funded catastrophic coverage plan.  Maybe the government reinsures the group through private insurance, don't know, let the numbers people figure that shit out.

All Americans are eligible for the new Medicare, without any age requirement.

Medicare Advantage type supplemental plans are subsidized by the government on a sliding scale means tested basis ranging from full subsidy to 0% subsidy. Medicaid is dissolved. 

Insurance is decoupled from employment. No large group or small groups, everybody goes to a national individual market.

You have to reassess the balance of the payroll tax.  The employer contribution needs to be bigger, the individual contribution much smaller. 

 FDA and healthcare pricing transparency reforms are also required.

 

I am sure there are some holes to punch in that sketch, and you would need some numbers people to work it for the right thresholds, but the goal IMO is a functional safety net protection so that nobody goes bankrupt if they get sick, a viable insurance market with a manageable risk pool, and some market dynamics to apply pressure to healthcare costs. 

Edited by Anastasis
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We don't want "death panels" but we still need to use common sense.

I don't have the exact numbers but there are stats that claim that people may use 80% (or some other high number) of their lifetime healthcare costs in their final year.   Which makes total sense when someone dies of a disease or old age.  Treating a life threatening disease is expensive.   But should we use Medicare dollars to incrementally extend someone's life or their quality of life?  

It's cold to use a cost-benefit analysis but perhaps some treatment should be denied unless the patient has their own means to pay.  I'm all for keeping someone pain-free and cared for, but that doesn't mean that all treatment should be covered.   

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44 minutes ago, Nice Guy Eddie said:

We don't want "death panels" but we still need to use common sense.

I don't have the exact numbers but there are stats that claim that people may use 80% (or some other high number) of their lifetime healthcare costs in their final year.   Which makes total sense when someone dies of a disease or old age.  Treating a life threatening disease is expensive.   But should we use Medicare dollars to incrementally extend someone's life or their quality of life?  

It's cold to use a cost-benefit analysis but perhaps some treatment should be denied unless the patient has their own means to pay.  I'm all for keeping someone pain-free and cared for, but that doesn't mean that all treatment should be covered.   

When you means test these programs they become much easier to take away from those without means. That's why they are for everyone, and that's the way it should be.

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4 hours ago, David Dennison said:

Because neither system is going to fail. We will fix Medicare by raising contributions and, in the case of Social Security, eliminating the upper limit of income subject to FICA. 

In other words, your taxes are going to go up before anything ever happens to those programs.

Payroll taxes and FiCA don't have an upper limit.

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4 hours ago, Dertyberd said:

Thank God we had the foresight to give huge tax breaks to the wealthy.  The jobs created will fill that payroll gap in no time along with the fake deficit they say is created.  

Just what I was thinking.  The wealthy will bail us out with their stock buybacks.

I'm so glad Paul Ryan managed to shore up SS and Medicare before he left Congress.  It's what he's always wanted to do.

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By 
David Harrison
Updated June 5, 2018 6:03 p.m. ET

The Social Security program’s costs will exceed its income this year for the first time since 1982, forcing the program to dip into its nearly $3 trillion trust fund to cover benefits.

This is three years sooner than expected a year ago, partly due to lower economic growth projections, according to the latest annual report the trustees of Social Security and Medicare released Tuesday. The program’s income comes from tax revenue and interest from its trust fund.

The trust fund will be depleted in 2034 and Social Security will no longer be able to pay its full scheduled benefits unless Congress takes action to shore up the program’s finances. Without any changes, recipients then would receive only about three-quarters of their scheduled benefits from incoming tax revenues.

The report also said that Medicare’s hospital insurance fund would be depleted in 2026, three years earlier than anticipated in last year’s report. Absent changes, the program then would be able to handle 91% of costs.

The nation’s aging population is boosting the costs of Social Security and Medicare, while revenue gains lag due to slower growth in the economy and the labor force.

About 61.5 million people receive retirement or disability benefits from Social Security and 58.4 million receive Medicare.

 

https://www.wsj.com/articles/social-security-expected-to-dip-into-its-reserves-this-year-1528223245

 

 
 

 

Edited by PittsburghTiger
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Compared to other wealthy democracies, the US has the highest levels of poverty and Americans live shorter, sicker lives than their Western counterparts.  So obviously the solution is to make matters even worse.  

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Just now, Fozzz said:

Compared to other wealthy democracies, the US has the highest levels of poverty and Americans live shorter, sicker lives than their Western counterparts.  So obviously the solution is to make matters even worse.  

They myth of America being the greatest country on earth is pernicious. We love to think we're number one in everything when in reality, we are a middling (almost backward) western democracy cruising on nostalgia.

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Just now, David Dennison said:

They myth of America being the greatest country on earth is pernicious. We love to think we're number one in everything when in reality, we are a middling (almost backward) western democracy cruising on nostalgia.

It's an abomination.

https://www.washingtonpost.com/news/wonk/wp/2018/06/06/an-explosive-un-report-shows-americas-safety-net-was-failing-before-trumps-election/?noredirect=on&utm_term=.34701801ba79

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Just now, ScottishHorn said:

They are just figuring this out?  

They've known for years that they are going to have to raise taxes, raise the Social Security upper limit, raise the retirement age, or reduce benefits.

I'm guessing it's anything but the latter.

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We have 2 parties that rarely have the courage to address major tax/spending issues.   When the economy is bad, they won't raise taxes or lower benefits as it would hurt too many people.  When times are good, we don't want to put a damper on the hot economy.   Hell, the last time we had budget surpluses we decided to give it back to the people instead of fixing problems that the people would eventually face.

The end result is that very little occurs.  Just like with everything in Congress they will wait until the last second to avoid catastrophe. 

 

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19 minutes ago, Nice Guy Eddie said:

... Just like with everything in Congress they will wait until the last second to avoid catastrophe political consequences / responsibilty.

If they act before the inevitable crisis that everyone with half a brain can foresee coming, then they get the blame when the crisis hits.  America isn't interested in root cause analysis.  We (collectively as society) bear some blame for their political calculus/cowardice.

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SS could be solved tomorrow if they simply raised the income limits of taxation.  High earners would then, in turn, get higher payouts but it would instantly solve the problem.

There is no solution to Medicare other than waiting for the olds to die off.

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22 hours ago, Ghost of LL said:

Tennesseehorn wonders what issue(s) the Democrats are going to run on, at the same time that this Administration gives them so many issues to run on.

Is this something that has come up in the past couple of years? Seems like they've been talking about Medicare and Social Security being in trouble since I can remember.

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Just now, Aqua Buddha said:

SS could be solved tomorrow if they simply raised the income limits of taxation.  High earners would then, in turn, get higher payouts but it would instantly solve the problem.

There is no solution to Medicare other than waiting for the olds to die off.

Olds are living longer, our chronic disease management and medical treatment options are improving...you are hoping for a plague cause natural attrition ain't gonna get it done. 

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10 minutes ago, Anastasis said:

Olds are living longer, our chronic disease management and medical treatment options are improving...you are hoping for a plague cause natural attrition ain't gonna get it done. 

Hence the problem.  Medicare is great in theory but in reality, it's paying for 30 years of health coverage during the most expensive time of your life.  It needs reforming now and not some grandfathered in later date.  We can't afford to be a giant military merged with a giant health coverage provider.  That's basically all we're spending money on at this point.

Ronald Reagan and the Democratic Congress passed meaningful SS reforms in his first term and the GOP had a historic chance to do the same.  However, Paul Ryan cared more about corporate tax cuts and share buybacks.  History will not look fondly upon this group.

Edited by Aqua Buddha
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23 hours ago, Bevo VIII said:

Why continue to pay something that is failing and will fail? How are we going to bail it out? Something new should be setup to replace. Why should younger generations continue to pay for older generations when we won’t receive the same benefits?

You can say that for about everything the government does with the majority of our taxes.

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1 hour ago, atomheartbevo said:

If the Democrats were competent, they’d figure out how to make this a major campaign issue this year and in 2020. 

How? It is a losing issue.

Making it a major campaign issue would entail making a pledge to raise payroll taxes or to cut benefits (or both).

That's also why nothing gets done.

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