Posted by
Publius North on Monday, June 13, 2011 10:06:37 PM
Among difficulties of
making the needed changes of the current Medicare Program to a more market-based
health care system for senior citizens is the profound and unfortunate sense of
entitlement among the citizenry as a whole. One can read about the sacrifices of the "greatest generation"
but their children, those about to inundate and drown the program, with notable
but few exceptions cannot easily be persuaded to give up government-paid health
care.
To expect a wholesale
change, even one gradually implemented in the future, is to hope for what is
near impossible. Congressman Ryan's plan
is a wholesale plan and it will eventually affect all citizens upon reaching the
age of 65. It may be that a compromise
on who is affected, and when, may help in the acceptance of what is, in its
totality, an overall common sense approach.
The compromise I offer,
which may achieve many of the same economic reforms intended by Congressman
Ryan, and, yet, will moderate what may be seen as its “harsh edges”, contains the
following moderate modifications:
- Retain the existing Medicare plan
but move the eligibility from age 65 to age 75. Let this apply to all those currently under
the age of 55.
- Implement a new Federal voucher
program for health insurance for those ages 65 to 75. This would be implemented
for those now under 55 when they turn 65. However, the new program should be immediately available on a voluntary basis for those above 55 upon turning 65,
and also those currently on Medicare under the age of 75.
This measure would
recognize the fact that citizens live longer than when Medicare was created
nearly 50 years ago, it would introduce market incentives and efficiencies and
would reduce the number of people dealing with the Federal bureaucracy. Federal budgeting also would be less
complicated and more predictable. Additionally,
more and more citizens continue to work until their early 70’s. By offering vouchers to senior citizens, this
can make their employment more attractive to companies where the voucher can be
applied to company group health insurance programs.
By making the voucher
program immediately available to those who turn 65 in the next eleven years,
and available to those currently on Medicare, (both on an optional and
voluntary basis), it will allow for a period of testing, correcting and
experimentation during the run up to full implementation.
It will, of course, be
necessary to establish reasonable market rules for companies who accept the vouchers.
This will be a challenge and difficult. How can we encourage reasonably attractive
rates for the aged? Obviously, there
will need to be a need to require a pooling of some risk with other age
groups. In addition, there will be a need
to establish a requirement not to drop seniors who get sick.
The proposed compromise
above accomplishes the moving of a large number of people to market-based
insurance policies. However, it will
also be necessary to legislate appropriate tort reform along with this measure
to minimize needless testing and defensive medicine. Discounts should apply for
seniors to take age appropriates measures to stay in good physical condition.
What about those citizens
over the age of 75? Two alternatives:
1.
They can continue to stay on the voucher plan up to age 80, or,
2.
They can move to the standard existing
Medicare program.
At age 80, all senior
citizens would then move from the market-based insurance program to standard
existing Medicare program.
I do not have the actuarial
data or the algorithms to run the calculations, but suspect the above would achieve
much of Congressman Ryan's objective while softening some of the reservations
many people may have with the plan as it now stands.
The Grey Gambling Medicare Tax:
As
one generally opposed to new taxes, I nevertheless propose a new tax to support
Medicare and the voucher program: A
daily Federal Tax of $10 will be assessed
each time any person enters a gambling establishment or casino for the purpose
of wagering or gambling. No one may
gamble in any game or machine without proof of purchase of the daily tax.