Medicare fix: raise deductibles & copays

[JEDI]

why not raise deductibles to $1000 and a scaled copay system:

$30 for first $100k in benefits paid
plus 20 percent between $100k & $1M
50 percent for $1M+

 

[Craig234]

There's a bottom line - who is going to get less and who more.

Are the average citizens, the Medicare recipients going to get less - or the rich who have had a huge wealth redistribution for decades?

We can cut the average American - it doesn't matter how, less benefits, shift to voucher that costs less, increasing co-pays, increasing FICA tax, or other cuts.

Or, we can pay for it with a shift back away from concentration of wealth - increased top tax rates, cap gains tax, estate tax, removing FICA cap, and so on.

That's the basic question - not finding some new flavor of 'make average Americans pay some new method'.

For part of it, there are other things - like investing more in reducing fraud, negotiating drug prices - that don't need to come from either, but that's not enough IMO.

 

[brencat]

Or, we can pay for it with a shift back away from concentration of wealth - increased top tax rates, cap gains tax, estate tax, removing FICA cap, and so on.

Agreed in bold, though as mentioned before, I'd want to structure it in a way that much/most of the upper middle class is shielded while the burden falls primarily on the top 0.5% of earners.

 

[Craig234]

Agreed in bold, though as mentioned before, I'd want to structure it in a way that much/most of the upper middle class is shielded while the burden falls primarily on the top 0.5% of earners.

Yes, I pretty much agree. That's where the lion's share of redistribution has gone.

If we can fix things with that, fine; if a bit more is needed, I could look at whether we should do more with the top 0.1%-0.5%, or start to look a little lower.

And I'm ok with looking at some cuts lower as well - we just need to lead with the top. They're the ones who have been getting massive shifts of wealth for a long time.

And while the economy recovers, we need the money going to average Americans.

 

[RightIsWrong]

why not raise deductibles to $1000 and a scaled copay system:

$30 for first $100k in benefits paid
plus 20 percent between $100k & $1M
50 percent for $1M+

At what point does insurance actually cover anything?

Why does the average person have to continue to contribute to insurance plans (including Medicare via payroll taxes) if the insurance plan doesn't actually provide any services/benefits?

The real solution is for the government to go to a universal health system, have a pay system that doesn't allow healthcare system to rape them and to cover all preventative treatments so that you are paying out for very inexpensive doctor visits instead of extremely costly treatments after the disease/condition has gotten to the point that basic medications are no longer effective.

 

[EagleKeeper]

Yes, I pretty much agree. That's where the lion's share of redistribution has gone.

If we can fix things with that, fine; if a bit more is needed, I could look at whether we should do more with the top 0.1%-0.5%, or start to look a little lower.

And I'm ok with looking at some cuts lower as well - we just need to lead with the top. They're the ones who have been getting massive shifts of wealth for a long time.

And while the economy recovers, we need the money going to average Americans.

And once the recovery happens then what - you are going to send it back?

 

[bpatters69]

Increased revenues or taxes may be part of the equation but what about reducing costs? I don't like giving politicians or gubmits more of our money as they are experts at finding ways to waste money. How about reducing malpractice and other frivilous lawsuits that plague our medical system? How about reducing medicare and medicaid fraud which reaches into the billions?

 

[Darwin333]

There's a bottom line - who is going to get less and who more.

Are the average citizens, the Medicare recipients going to get less - or the rich who have had a huge wealth redistribution for decades?

We can cut the average American - it doesn't matter how, less benefits, shift to voucher that costs less, increasing co-pays, increasing FICA tax, or other cuts.

Or, we can pay for it with a shift back away from concentration of wealth - increased top tax rates, cap gains tax, estate tax, removing FICA cap, and so on.

That's the basic question - not finding some new flavor of 'make average Americans pay some new method'.

For part of it, there are other things - like investing more in reducing fraud, negotiating drug prices - that don't need to come from either, but that's not enough IMO.

Have we ever in history collected revenue, as a percentage of GDP, that would cover our current spending, again as a percentage of GDP? How about when you factor in the projected increases in Medicare and Social Security over the next few decades or so?

 

[Schadenfroh]

Medicare needs an overhaul, but he who touches it, even with benevolent intentions, will surely face political death.

Easier to reform Medicaid first.

 

[the DRIZZLE]

Yes, I pretty much agree. That's where the lion's share of redistribution has gone.

If we can fix things with that, fine; if a bit more is needed, I could look at whether we should do more with the top 0.1%-0.5%, or start to look a little lower.

And I'm ok with looking at some cuts lower as well - we just need to lead with the top. They're the ones who have been getting massive shifts of wealth for a long time.

And while the economy recovers, we need the money going to average Americans.

I agree that the top 0.5-0.1% are undertaxed (at least on a relative basis), but we need to be honest about the situation. Should we collectively pay an ever increasing amount for end of life care, whether through medicare or private insurance? Does it make sense to pay enormous amounts of money to keep people alive for an extra six months? Saying that the rich should pay for it is just avoiding a difficult question. Soak the rich is the universal liberal answer to every problem, but the fact is we live in a world with finite resources and we need to honestly ask ourselves if spending them in this way is wise.

 

[brencat]

I agree that the top 0.5-0.1% are undertaxed (at least on a relative basis), but we need to be honest about the situation. Should we collectively pay an ever increasing amount for end of life care, whether through medicare or private insurance? Does it make sense to pay enormous amounts of money to keep people alive for an extra six months? Saying that the rich should pay for it is just avoiding a difficult question. Soak the rich is the universal liberal answer to every problem, but the fact is we live in a world with finite resources and we need to honestly ask ourselves if spending them in this way is wise.

Who is to say a person 'only has 6 months left to live' ? What if it turned out to be years more time?

More importantly, if you had the means or access to insurance, what would you be willing to pay to keep that loved one of yours alive for another 6 months, no matter their age or condition? Would you want the government to make that decision to deny potentially life-prolonging drugs or procedures?? I sure as shit wouldn't. That's a family decision right there.

Your comments are suggestive of a 20-something without a family who is as far removed from death and old age as my little kids. Wise up.

 

[JS80]

If you raise the capital gains tax rate, investors will just never sell and shift towards tax deferred investment products and you will not see an increase in revenue

 

[ProfJohn]

The problem isn't revenue, it is spending.

We are spending more today as as percentage of GDP than any time since WW 2.

The best short term thing we can do is eliminate waste via over usage by doctors who get paid by service and thus ask for more and more tests without really needing the results.

Same with coming up with ways of keeping patients from asking for more and more tests that they don't have to pay for.

A month ago I had some severe back pains and went to the minute clinic where I have a $10 co-pay. But they don't treat back pain and suggested an emergency clinic with a $50 co-pay. I decided to take some pain bills and a cold pack and relax for the rest of the day.

People with Medicare need to be making the same type of decisions instead of thinking of it as an all you can eat for free buffet.

 

[ProfJohn]

Yes, I pretty much agree. That's where the lion's share of redistribution has gone.

If we can fix things with that, fine; if a bit more is needed, I could look at whether we should do more with the top 0.1%-0.5%, or start to look a little lower.

Craig, we need to nearly DOUBLE the amount of money we raise via taxes.

Do you really think you can get that much money from such a small group of people without severe consequences?

At some point the rich stop worrying about making money and start working on hiding that money from the government at which point we are really screwed as tax revenue goes down and economic activity goes down too.

It is no coincidence that the longest economic recovery in history started after one of the biggest tax cuts in history.

 

[DCal430]

why not raise deductibles to $1000 and a scaled copay system:

$30 for first $100k in benefits paid
plus 20 percent between $100k & $1M
50 percent for $1M+

The copay for Medicare is already too high. I know someone who needed an Adaptive Servo Ventilator or ASV machine at night for apnea, and had to pay close to 3000 in a copay for Medicare. A 20% copay is required on medical equipment and supplies for medical equipment for Medicare. Being on a fixed income 20% is excessive for something you need to live.

The real solution is a single provider system, in which everyone is treated under a government run healthcare system.

 

[fskimospy]

Craig, we need to nearly DOUBLE the amount of money we raise via taxes.

Do you really think you can get that much money from such a small group of people without severe consequences?

At some point the rich stop worrying about making money and start working on hiding that money from the government at which point we are really screwed as tax revenue goes down and economic activity goes down too.

It is no coincidence that the longest economic recovery in history started after one of the biggest tax cuts in history.

Actually it is a coincidence.
1.) There is no statistically significant correlation between marginal tax rates for the rich and economic growth.

2.) What you are trying to describe is being on the wrong side of the Laffer curve, and there is no evidence whatsoever that we are anywhere close to it.

 

[QuantumPion]

At what point does insurance actually cover anything?

Why does the average person have to continue to contribute to insurance plans (including Medicare via payroll taxes) if the insurance plan doesn't actually provide any services/benefits?

You keep using that word. I do not think it means what you think it means.

 

[brencat]

Craig, we need to nearly DOUBLE the amount of money we raise via taxes.

Do you really think you can get that much money from such a small group of people without severe consequences?

At some point the rich stop worrying about making money and start working on hiding that money from the government at which point we are really screwed as tax revenue goes down and economic activity goes down too.

It is no coincidence that the longest economic recovery in history started after one of the biggest tax cuts in history.

Don't think we are anywhere near the rich wanting to hide their money or focusing on tax deferred investments. Sure, if we raise cap gains taxes there will be a drop in market liquidity as some sales are deferred/delayed, but perhaps we'll get less speculation too.

At the end of the day, there is a massive disconnect between how salaried income is taxed vs investment income. And that has to change, particularly for the top 0.5%. From a fairness perspective, if we did nothing else besides raise the cap gains tax to 25%-28% and did away with the 15% carried interest provision, that would be a huge step.

 

[JockoJohnson]

You keep using that word. I do not think it means what you think it means.

Ah, The Princess Bride. Great movie. And I agree with the use of the word...or rather, the misuse.

 

[Craig234]

And once the recovery happens then what - you are going to send it back?

Why, yes, that's the plan. During recession, when the government spends more to keep the economy functioning in a downtime of consumer and business spending, the plan is for the stimulus money to be put into banks, and wait for things to get better, and then returned to the government. And I thought you were ignorant!

 

[Craig234]

Actually it is a coincidence.
1.) There is no statistically significant correlation between marginal tax rates for the rich and economic growth.

2.) What you are trying to describe is being on the wrong side of the Laffer curve, and there is no evidence whatsoever that we are anywhere close to it.

One thing not mentioned in PJ's post - I don't care to go over others - is the word "debt" does not appear in his statement.

The US went from 200 years of low peacetime deficits, to a Republican policy of huge permanent deficits; borrowing many trillions CAN have some short-term benefit.

 

[Craig234]

The problem isn't revenue, it is spending.

We are spending more today as as percentage of GDP than any time since WW 2.

The best short term thing we can do is eliminate waste via over usage by doctors who get paid by service and thus ask for more and more tests without really needing the results.

Same with coming up with ways of keeping patients from asking for more and more tests that they don't have to pay for.

A month ago I had some severe back pains and went to the minute clinic where I have a $10 co-pay. But they don't treat back pain and suggested an emergency clinic with a $50 co-pay. I decided to take some pain bills and a cold pack and relax for the rest of the day.

People with Medicare need to be making the same type of decisions instead of thinking of it as an all you can eat for free buffet.

Why yes, the answer to Medicare is stop using medical services. Great solution.

When I had some back pain and went to Kaiser, they referred me to a physical therapist, who supplied me with some prepared information on exercises.

They worked great! Boy, what a waste it was to use that service.

And everyone who goes to Medicare for back pain, and other problems, is just as able to 'suck it up' and use an ice pack for a day as you were in that case.

Your other comments are just too clueless to bother with - not a word you say, for example, has to do with WHO is taxed - how taxes have been shifted off the rich.

No issue there! Who cares about massive redistribution of wealth to the top, about all the economy's growth since Reagan going to the top 20%, especially the top 0.1%?

Who cares about the massive Republican debt and its interest payments, etc.?

Who cares about the lost trillions to excessive military spending, to supporting the private medical healthcare industry instead of the far more efficient single-payer?

 

[Craig234]

I agree that the top 0.5-0.1% are undertaxed (at least on a relative basis), but we need to be honest about the situation. Should we collectively pay an ever increasing amount for end of life care, whether through medicare or private insurance? Does it make sense to pay enormous amounts of money to keep people alive for an extra six months? Saying that the rich should pay for it is just avoiding a difficult question. Soak the rich is the universal liberal answer to every problem, but the fact is we live in a world with finite resources and we need to honestly ask ourselves if spending them in this way is wise.

95% of what is said about liberals here is wrong or lies, I can't remember the other 5%.

Your post is quite reasonable except for misrepresenting liberals.

The reason we're going on about the need to increase taxes on the rich has more to do with a *historic shift in their favor leading to record concentration of wealth*.

 

[ElFenix]

Have we ever in history collected revenue, as a percentage of GDP, that would cover our current spending, again as a percentage of GDP? How about when you factor in the projected increases in Medicare and Social Security over the next few decades or so?

iirc, postwar peak for revenue as a % of GDP was 1999 at just about 20%. despite all the changes in the tax code over th years the % of revenue for GDP has been between 17% and 19% for just about all of the last 50 years

graph

 

[Craig234]

Have we ever in history collected revenue, as a percentage of GDP, that would cover our current spending, again as a percentage of GDP? How about when you factor in the projected increases in Medicare and Social Security over the next few decades or so?

There's no way we can cover coming expenses in Medicare without cost control reforms.

Social security needs some relatively modest reforms as well.

We also face a problem repaying the trillions the country has borrowed from the Social Security 'trust fund', which is not the fault of Social Security.

We need a combination of things, some rollback of tax cuts for the rich, some control, etc.