That’s correct. And, the cuts would be across the board – people with low benefits would see the same percentage cut as people with high benefits.
The projection for 2026 is that SS taxes will only cover 86% of benefits. SS will be contributing $234 billion to the combined deficit. RDO could recommend that we immediately cut benefits by 14%, then cut more in later years as benefits continue to outrun taxes.
I believe that the “It” refers to Medicare. How do you recommend self-funding Medicare?
Where to draw the line on the value of a QALY? Do we stand up some sort of panel to sort this out?
Not all of medicare, but medicare writing a big check for a low probability at a small amount of QALYs sounds like a terrible use of public funds. That should be self funded.
Yes, the actuaries can decide!
Sure, so we really don’t need medicare at all since we have medicaid.
Are you proposing medicaid for all? Or medicare for all? Nothing for all?
ISWYDT. I’ve been trying to be on those panels since the earliest rumors of them. thanks obama!
Thats already in the GOP Budget.
They plan to cut $880bn from Medicaid. I don’t think they will touch SS, but from the looks of things they will try to force down drug prices to bring down Medicare costs (this has been tried before and is a good idea. Problem is they need massive discounts which the pharma sector will fight).
Should have put this in my original post, but this is kind of what I mean by the math simply does not add up.
$1.8T deficit (including about $1T in debt service costs)
Igoring the morality of gutting medicaid, they would need to bring down costs for medicare by about $1T if they don’t touch SS.
Okay. “Self funded” means Medicare doesn’t cover some things. Some people can and will reach into their own assets. Others can’t or won’t.
Do you have a source that says how many dollars are involved?
I was assuming that RDO was looking for much larger cuts than $880 from Medicaid over 10 years, maybe some drug savings from Medicare, and no cuts to SS.
That’s a lot of assumptions. Especially when I specifically called for raising SS retirement age and work on SSDI.
BTW: This may help. It only analyzes current expenditures but would serve as a starting point.
Interesting addition to the mix…
You are correct, I shouldn’t have been so dismissive. I tend to think that proposals for raising the retirement age have a significant impact 30-50 years from now, but have very little impact in the 10 year budget window. You didn’t specify a plan. The SS actuaries have scored 15 possibilities. Probably your idea is close to something on their list and you can use their numbers to determine the impact of the change. Long Range Solvency Provisions
I’m reacting to your statement that the big dollars in budget discussions are are in Medicaid, Medicare, and SS. How many dollars are you thinking we can get from Social Security retirement age?
What you said was that the DI fund is running out of money. This isn’t what the SS actuaries say. How would you work on SSDI? How many dollars would you save?
That report uses 20/20 hindsight. Once we know that an individual has died, then we can go back and see how much money Medicare spent on the individual in the last 12 months.
The problem is that policy requires foresight. When do we refuse to provide services because we can see that we are just adding a few heartbeats for and individual with a very poor quality of life?
I’m looking for the study that interviews doctors about their thoughts during care. How about getting doctors to say “At this point, had it been my father, I would have been telling him that he would be better off with hospice care than spending his final days getting procedures in a hospital.” The researcher can get a potential expense saving from that, then we can move on to the difficult question of how the gov’t can facilitate that decision. Medicare already provides coverage for hospice services, what more can it do?
There are similar questions for procedures, e.g. “If it had been me, I wouldn’t have said yes to that lase round of chemo.” What’s the potential, and how does the gov’t get people to make the cheaper choice?
The article mentions profit-seeking Medicare Advantage providers. Since they have a clear financial incentive to encourage the cheaper choice, they ought to have different results from traditional Medicare. That would be a useful study.
What I’m guessing is that the dollars available from increasing the NRA, fooling with SSDI approvals, and encouraging cheaper EOL decisions are real, but they are small relative to the size of the deficit.
When my uncle was dying, I think there was a 1-2 week difference between when my dad and uncle made the call to suspend care and when the doctors would have done it for a family member. I suspect part of the delay was their (my dad and uncle) unwillingness to raise the issue with the doctors. From my understanding, they were strangely uninvolved while he was hospitalized.
My father decided to set up a durable power of attorney for healthcare in the event he is not capable to make healthcare decisions for himself. He deliberately named a physician rather than a family member or close friend, largely so that a provider would make the logical decision rather than an emotional one.
There are policies besides cost cutting that can reduce the deficit, and ultimate at least slow the rate of increase in the national debt.
The first thing that comes to mind is taxation. I’ve seen a wide range of positive impacts from simply putting in an inheritance tax. Often in the trillion dollar range in a 10 year horizon. And let’s bear in mind that this search is for the ability to reduce taxes…which is just plain wacky. No one serious about deficit reduction should fail to realize that.
Next, the whole tariff thing -devalue the dollar while simultaneously increasing the long term cost of borrowing, is scary. Heads in exactly the wrong direction. But we don’t appear to have that option available for the next 3 1/2 years.
You might even consider how to lower the ridiculous health care costs in the US. Especially since the government supplies the majority of the funding. Lotsa meat on that bone. Simply reducing Medicaid outlays is a pretty inefficient mechanism there. There’s plenty of alternatives to our private HC with fee for service pricing. Pick one.
Freakonomics had an interesting podcast about how, relative to Europe, the US has very progressive taxes. Not because high income earners pay way more but because so much of America pays so little, whereas in Europe they pay significantly more.
Do you know if the physician was his PCP, or somebody that specializes in providing that service? I wonder what my PCP would say if I asked him to do that.
It was not his PCP. Not sure how he found this guy.