Tax the Rich: Fix Jobs and Deficits

[Greenbeard]

If Medicare's primary problem stems from health care inflation, that would seem to explain the secondary problem of a long term Medicare deficit. Would indexing the payroll tax to actual health care costs solve both issues?

It seems to me the deficit's solved because as Medicare's costs go up, it's funding will rise at the same time.

Raising taxes, yes, but with the understanding the more taxes you pay, the more you get back in health care benefits.

Perhaps, but you're still left with the imperative to get a handle on rising health costs.

Much of what you have pointed out are wonderful ideas but in the end it is not how Medicare operates that is the problem but the amount of Medicare that is needed.

And yet there isn't much of a distinction between those two things. Payment policies that promote volume over value increase the "amount of Medicare" consumed, be they full price payments for a preventable readmission or fee-for-service inducements for additional services. Lack of care coordination, particularly for the most expensive segment with chronic conditions (e.g. many dual eligibles), drives up the amount of Medicare needed. The design of service delivery has a huge impact on how much Medicare (or care purchased by any payer, for that matter) is needed. And the tools available at the point of service are important, like an electronic health record providing clinical decision support.

We want and deserve more health bang for our Medicare buck--we want better value. And there's a huge amount of room in our system to get that. That's the strand of reform that's being pursued so far. That will be an iterative process of building, learning, and refining, but beyond that the next steps should be to start thinking about benefit designs and cost sharing and who's financing this.

As for the retirement age, if you look at Lieberman-Coburn, that raises the retirement age to 67 but only on the condition that the state-based insurance exchanges of the ACA exist for folks to use in finding individual insurance coverage; if the ACA were repealed, that provision of their bill vanishes and the retirement age reverts back to 65. Leaves me wondering whether the additional exchange subsidies for those 65-66 who need coverage through an exchange would actually cost the feds less than Medicare would for that same cohort; presumably it would, otherwise that particular proposal makes no sense. Still, I wonder.

 

[thereisnospoon]

End third party payment systems (be they government plans or palns based on where you work) and the cost of medicine will drop like a stone in water.

Most hospitals will close due to a lack of funding, so even if you happen to be well heeled, you still probably won't be able to get the health care you need.

Public hospitals are funded with taxpayer dollars and donations from wealthy people who want their name on a wing of the building.

 

[FireFly]

Democrat hero John Maynard Keynes and the Laffer Curve

"Nor should the argument seem strange that taxation may be so high as to defeat its object, and that, given sufficient time to gather the fruits, a reduction of taxation will run a better chance than an increase of balancing the budget."

 

[bripat9643]

If Medicare's primary problem stems from health care inflation, that would seem to explain the secondary problem of a long term Medicare deficit. Would indexing the payroll tax to actual health care costs solve both issues?

It seems to me the deficit's solved because as Medicare's costs go up, it's funding will rise at the same time.

Raising taxes, yes, but with the understanding the more taxes you pay, the more you get back in health care benefits.

ROFL!

That may "solve" the problem of Medicare not having enough money, so long as you don't mind not having enough money for food and rent.

That's a prescription for bankrupting the entire country.

leftwingers are so funny!

 

[georgephillip]

"No one likes paying taxes – least of all Americans.

"But, despite well-worn assertions to the contrary, Americans are not paying too much – at least not by historical standards, not compared to other developed countries, and most importantly, not in light of the revenues needed to maintain the size of government that Americans want.

"Households in the middle of the income spectrum paid an average of 13.9 percent of their income in federal taxes in 2004 (the most recent year available), according to the Congressional Budget Office. That’s the lowest share since CBO began collecting this data in 1979 (except for 2003, when it was 13.8 percent). These figures include all federal taxes, such as income, payroll, and excise taxes.

"Federal taxes have declined mostly because federal income taxes have declined significantly. The median-income family of four paid only 5.8 percent of its income in federal income taxes in 2006. These 'effective tax rates' are the lowest in at least half a century."

The Ripon Society...The Home of Ideas

Maybe brain-dead right-wingers should stop laughing long enough to tell the Pentagon to stop stealing from US taxpayers.