Medicare fix: raise deductibles & copays

[ElFenix]

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

cutting taxes isn't always the answer just like more regulation isn't always the answer. the business cycle will never be fully tamed, we can only hope to make it a bit more like a moving average.

and which expansion period are you referring to because seems to me that over the last 40 years the economy has been beholden more to the price of oil than anything else. price of oil down, good economic times, price of oil high bad economic times.

 

[Darwin333]

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.

Since Craig skirted the question, I will ask the exact same question of you:

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?

And "some cuts" don't cut it for an answer.

 

[Darwin333]

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

Didn't we add more debt than ever in history during that same period as well? Could that possibly have anything to do with the perceived recovery?

Wanna guess what happens to the economy if the .gov pulls out a large percentage that it is currently injecting with borrowed money? Simple math says it must contract by at least as much as it pulls. While I believe it is necessary lets not pretend that there are no consequences, I just believe the consequences of not doing so is far greater.

 

[ElFenix]

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.

well, the whole thing was set up by people who have no clue how math works so yes, it is the fault of social security. they either should have set it up to be fully funded from the get go or completely pay as you go and adjusted up/down as necessary rather than making a surplus (which by law has always been sent directly to congress as social security can only buy a certain class of treasuries). it's just robbing peter to pay paul.

 

[Darwin333]

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.

Could you be more specific about what kind of percentage of "cost controls" we are talking about here?

Last fiscal year we had to borrow money to pay the electric bill at the White House after we covered mandatory expenses (Medicare, Medicaid, Social Security, interest on the debt and thats it).

 

[DCal430]

One of the biggest frauds in Medicare is fraud by durable medical equipment (DME) providers who bill Medicare for equipment never provided to patients. There is one easy way to eliminate all of this fraud. Currently DMEs require a 20% copay for Medicare, and the patient is billed for this directly from the DME provider. In fraud cases these fake patients are never billed and only Medicare is billed for their 80% portion.

A very simple solution would be to have Medicare pay 100% of the DME cost directly and bill the patient for a 20% reimbursement them self. This would allow them to verify the patient actually received this service.

This would eliminate the largest amount of Medicare fraud.

 

[Darwin333]

well, the whole thing was set up by people who have no clue how math works so yes, it is the fault of social security. they either should have set it up to be fully funded from the get go or completely pay as you go and adjusted up/down as necessary rather than making a surplus (which by law has always been sent directly to congress as social security can only buy a certain class of treasuries). it's just robbing peter to pay paul.

I disagree. They knew exactly how the math worked, Social Security was and has been primarily a way to generate revenue. If it wasn't then they could have easily used the excess funds to buy actual treasury bonds that bear the full faith and credit (same ones we sell to anyone else) and actually turned a profit and held Congress responsible for the money borrowed from it. Instead they allowed it to be borrowed on basically the word of politicians that knew they likely wouldn't be around when the bill came due. I don't trust a politician when he will be at the same table as me when the bill comes.

 

[the DRIZZLE]

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.

What would you pay to keep yourself alive for another year? If you had a million dollar inheritance that you wanted to pass on would you burn it to spend an extra year living like shit in and out of hospitals? If not why do you expect other people to pay for it?

The who's to say problem is tricky. I actually don't have a huge problem with the government denying care because I don't view healthcare as a right. In countries with single payer health care the government does it already. (i.e.dealth panels) Under the Ryan plan different insurance companies would eventually set their own rules and people would have to pay more for policies that provided more coverage.

I think the OP has the right idea with making people have more skin in the game. I don't have an easy answer, but we cant afford to keep doing what we are doing now.

 

[Craig234]

well, the whole thing was set up by people who have no clue how math works so yes, it is the fault of social security. they either should have set it up to be fully funded from the get go or completely pay as you go and adjusted up/down as necessary rather than making a surplus (which by law has always been sent directly to congress as social security can only buy a certain class of treasuries). it's just robbing peter to pay paul.

Boy, you are getting stuff wrong.

Think about the different circumstances when it was set up from 50 years later. What changed? You're the one with math issues not to get the changes.

The people who set it up did just fine for decades (proving the Republicans who said it would not last at all wrong).

Yes, after decades, the changing demographics required adjustment. Unfortunately, the American people had given that task to the worst people on the planet, short of Joe "Crazy Guy Who Eats Wallpaper Paste" Rodriguez in Grenada, Ronald Reagan and Alan Greenspan, who came up with a way to use the issue to raise huge amounts of money - while then throwing that money away by letting the government borrow and spend it off the books.

The program itself - the most successful in history, perhaps, reversing elder poverty from 90% to 10%, very popular - which is why Republicans want it gone.

What Reagan and Greenspan did, what Congress and Presidents borrow, are not the fault of Social Security, they're the fault of the politicians and the voters.

Social security itself can continue as a great retirement program indefinitely, with some adjustments for the changing demographics.

We don't need 'reform' from a group of people - Republicans - who have the motive to destroy it to deny Democrats any political benefit, and shift wealth to the top.

 

[chowderhead]

there should be a commission that is set up to reform Medicare and/or Social Security but should be run like what they do with the base closing. The President and Congress should appoint a bi-partisan commission. There should be hearings and proposals and testimony from experts and actuaries, doctors, members of the public, etc. The commission hammers out a set of proposals and reforms and sends the plan to Congress. The entire bill has to be passed or rejected without any modifications. We need to be honest about entitlement reform but then we need to honest about funding unending wars and tax cuts for everyone. The current rate of spending and revenues is not sustainable.

 

[ProfJohn]

Didn't we add more debt than ever in history during that same period as well? Could that possibly have anything to do with the perceived recovery

The debt added during the Reagan years is nothing compared to the debt we are adding now.
If all that deficit spending is what caused that great expansion then why isn't the current deficit spending resulting in an expansion?

There were a LOT of factors that caused the expansion that took place between 1982 and 2000 (with a very small recession within that period)

But let's not debate that topic in this thread and focus on the main point which is the fact that we have NEVER raised enough revenue as percentage of GDP to cover our current spending. To think that we can raise rates on a small portion of the population and see revenue jump by a trillion dollars is crazy. Beyond crazy actually.

We would have to DOUBLE the amount of money raised by income to even come close to balancing the budget. Do you really think we can do that by raising taxes on 1% of the population?

Do you really think the 'rich' have a trillion dollars a year in income that we can tax from them??

Let Zebo post about how banks gave out $400 billion in bonuses last year and realize that if they instead gave that money directly to the government it would only cover about a third of our current yearly deficit.

 

[Throckmorton]

The debt added during the Reagan years is nothing compared to the debt we are adding now.
If all that deficit spending is what caused that great expansion then why isn't the current deficit spending resulting in an expansion?

There were a LOT of factors that caused the expansion that took place between 1982 and 2000 (with a very small recession within that period)

But let's not debate that topic in this thread and focus on the main point which is the fact that we have NEVER raised enough revenue as percentage of GDP to cover our current spending. To think that we can raise rates on a small portion of the population and see revenue jump by a trillion dollars is crazy. Beyond crazy actually.

We would have to DOUBLE the amount of money raised by income to even come close to balancing the budget. Do you really think we can do that by raising taxes on 1% of the population?

Do you really think the 'rich' have a trillion dollars a year in income that we can tax from them??

Let Zebo post about how banks gave out $400 billion in bonuses last year and realize that if they instead gave that money directly to the government it would only cover about a third of our current yearly deficit.

LOL. The fact that BONUSES in ONE industry can cover 1/3 the deficit doesn't back up your argument. The fact is, that top 1% doesn't pay much taxes and takes a huge share of national income, and own an even bigger share of national wealth. Taxing them a little more would put a big dent in the deficit.

 

[Doppel]

Craig has read enough and knows that even if the rich were taxed until they bled there wouldn't be enough money. It would help, and they should pay more at this point, but the rest of us are going to have to suffer a little pain, the math demands it and the math always gets its sacrificial lambs.

Maybe in the future, but now this country lacks the wealth for every blue collar worker to sit on their ass for years and years on end collecting benefits and first world health care, whether on welfare, disability, or in retirement. That's the story that is told by the screwed up budgets that get screwed up more each year.

Raising deductibles may be a good idea but as a politician if you push it the 30 second sound bites will ask why you hate old people or why you hate the poor and then have an ominous gong sound as it cuts you shaking hands with some CEO and impact text saying "<your name> Not the working man's man".

 

[ProfJohn]

LOL. The fact that BONUSES in ONE industry can cover 1/3 the deficit doesn't back up your argument. The fact is, that top 1% doesn't pay much taxes and takes a huge share of national income, and own an even bigger share of national wealth. Taxing them a little more would put a big dent in the deficit.

I think you totally missed the point.

People like Craig and others argue that if we just raise taxes on the rich we can solve all our problems.

Let me put it to you this way:
In 2008 (last year we have detailed numbers) the top 1% had an Adjusted Gross Income of $1.6 trillion.

In 2008 the deficit was over $1 trillion.

Which means if we took 100% of all money earned by the top 1% we would still NOT be able to cover our year budget deficit.

 

[ProfJohn]

But the rich make all their money in capital gains....

That may be true, but look at revenue generated by capital gains taxes.
Revenue from capital gains taxes appears to have hit its peak in 2000 with $119 billion in revenue.

So let's say we reached that peak again and we DOUBLED the tax rate on those gains. That would give us around $300 billion more in revenue after adjusting for inflation.

Sure that is a lot of money, but we are looking at $1.4 trillion deficit this year so that $300 billion is barley a dent in our total deficit.

 

[ProfJohn]

BTW raising the capital gains tax rate from 15 to 20&#37; on people making over $250,000 will only gain us $100 billion more in income over a 10 year period.

$100 billion in nothing compared to our $1+ trillion yearly deficit.

 

[Craig234]

People like Craig and others argue that if we just raise taxes on the rich we can solve all our problems.

How many times have I told you to stop lying about what I say? I've lost count and can't remember the last time you accurately quoted me.

Doppel did just fine.

BEFORE your post.

Craig has read enough and knows that even if the rich were taxed until they bled there wouldn't be enough money. It would help, and they should pay more at this point, but the rest of us are going to have to suffer a little pain, the math demands it and the math always gets its sacrificial lambs.

It's one important thing for us to do. Not just the direct revenue, but a variety of benefits.

Increasing opportunity for more people, reducing the concentration of wealth, reduce somewhat the political donation corruption, increase productivity, etc.

 

[QuantumPion]

It's one important thing for us to do. Not just the direct revenue, but a variety of benefits.

Increasing opportunity for more people (so they can pay more taxes), reducing the concentration of wealth (by making people pay more taxes), reduce somewhat the political donation corruption (by taxing people's wealth before they can donate it to politicians I disagree with), increase productivity (so they can pay more taxes), etc.

FTFY.

 

[ProfJohn]

It's one important thing for us to do. Not just the direct revenue, but a variety of benefits.

Increasing opportunity for more people, reducing the concentration of wealth, reduce somewhat the political donation corruption, increase productivity, etc.

How does taking money from one group of people result in more opportunity for others? Or increase productivity?

Any evidence to back up these claims?

 

[infoiltrator]

Remember copays are a personal user tax outside of spendable income and keeps people from seeing doctors early.
The one payer plan, instead if passing payments through endless beaurocracy will effect the profitability of many entrenched interests. It remains the most viable means to reduce medical costs.
Usually the people who need help most are the ones who can least afford it.

 

[ElFenix]

Boy, you are getting stuff wrong.

Think about the different circumstances when it was set up from 50 years later. What changed? You're the one with math issues not to get the changes.

The people who set it up did just fine for decades (proving the Republicans who said it would not last at all wrong).

Yes, after decades, the changing demographics required adjustment. Unfortunately, the American people had given that task to the worst people on the planet, short of Joe "Crazy Guy Who Eats Wallpaper Paste" Rodriguez in Grenada, Ronald Reagan and Alan Greenspan, who came up with a way to use the issue to raise huge amounts of money - while then throwing that money away by letting the government borrow and spend it off the books.

The program itself - the most successful in history, perhaps, reversing elder poverty from 90&#37; to 10%, very popular - which is why Republicans want it gone.

What Reagan and Greenspan did, what Congress and Presidents borrow, are not the fault of Social Security, they're the fault of the politicians and the voters.

Social security itself can continue as a great retirement program indefinitely, with some adjustments for the changing demographics.

We don't need 'reform' from a group of people - Republicans - who have the motive to destroy it to deny Democrats any political benefit, and shift wealth to the top.

the math that the people who set it up didn't figure out is compound interest. you know, the most powerful force in the universe. they also didn't figure out COLA or that there would be declining number of contributors to retirees (a problem with all pay as you go pensions). in fact, there is basically no math in the 1935 act, so they had to start fixing it in 1950 (hardly decades and certainly not 50 years later).

social security's tax rate has been adjusted upward continually since the program's inception. so, if decades mean 'after 15 years and then continuously afterward.' why? because the number of workers per retiree has always been falling. they probably figured that would happen back in 1935 but who knows. though there was no math at all in the 1935 law so maybe not. so in 1950 there was a 77% COLA, a 20% increase in the wage ceiling and 50% increase in the tax rate. there were a total of 16 increases in the tax rate before 1983.

again, there was no math, so that's pretty strong evidence in favor of my assertion that it was set up by people who don't understand math.

so, the rate has been adjusted upward. often. that didn't change in 1983. the amount of income subject to social security has continually been increased upward. that didn't change in 1983. the program has to buy government bonds. that didn't change in 1983. the government used a unified budget.* that didn't change in 1983.

looking at it the only thing that really changed is that automatic COLAs have been lower since then, but unless there's been some change in how CPI-W is tabulated that's just due to stagflation's end at the same time. 1984 is the only year in which the wage measure would have served as the basis for COLA but i don't see anything that says it was used. the one thing that changed legally is that a portion of social security benefits became taxable.

anyway, if you'd have read my post you'd see that either of my proposals would have prevented the government from stealing the trust fund, republicans and democrats.








*side note: raygun actually proposed taking it out of the unified budget, which makes deficits appear larger compared to unified budget, but not until well after he'd left office. johnson invented the unified budget because squabbling over which budget measure was to be used consumed a lot of congress's time. since 1990 it has been off budget.