You're confusing me with this data . . . unsourced, I might add. This has nothing to do with whether or not a Medicare model would work. The model would work. It's the taxes collected for it that would have to change.
There is literally no way that we will be able to collect enough taxes to cover Medicare as it is
currently structured. Under no tax structure in the history of the United States of America have we ever managed to collect the kinds of taxes that would allow Medicare at its'
current structure to survive the 2020s. Expanding Medicare under
any tax structure with
any rates in the manner that you are describing will only collapse the system immediately instead of in the future.
And not that far in the future, either. Those comments about the 2020s are assuming that Congress basically eventually caves on funding the ACA over Medicare.
Medicare Trustees: Medicare Will Go Broke in 2024. Unless You Discount The ACA's Double-Counting. Then It Goes Broke in 2016.
As we shine a bright light on the cost of treatment and the cost of insurance to cover said treatment, as we increase premiums to accurately reflect projected losses, people will suddenly become outraged that their doctor is charging them $130 for 10 minutes of his time. As their deductibles rise, they will question themselves before running to the ER and wonder whether or not they really need that CT scan for a broken arm. When more money is coming out of their pockets, costs will go down.
Higher deductibles will absolutely re-introduce cost sensitivity and have the effect of putting downward pressure on prices.
Problem: Higher Deductibles are "mean", and "some care should be 'free'". Telling people that they need to suck up the cost of their healthcare when the political rewards go to the folks who promise free preventative, free birth control, free for the old, free for the poor, free for the young, is going to be a losing proposition.
But if we were to put America on a high-deductible, catastrophic care
only market, that would indeed go far towards reducing the prices we pay for healthcare. It's just that (at current) the government cannot afford to do that itself.
Medicare's "unfunded liability" is $24 trillion. Social Security $21 trillion. (Based on 2010 numbers)
PolitiFact Florida | Romney says debt plus unfunded liabilities equals $520,000 per household
I goofed this - the 64 figure in my head was the combined unfunded liability for our entitlements, not Medicare.
Medicare's Unfunded Liability, as of April 2012, was
$38.6 Trillion. And, (again) is currently scheduled to go broke in either three or eleven years, depending on whether or not we keep the ACA as it is currently structured.
These numbers are misleading because they make the assumption that everything will remain exactly as it is -- expenditures, benefits and premiums. That's not going to happen.
That is precisely what I am saying - unless we are willing to basically tell old people who cannot afford care to go home and die, we aren't going to be able to expand Medicare as you envision. We aren't willing to do that (old people vote).
People making $100,000+ in retirement should be paying a great deal more for their Medicare insurance. Not just a few hundred dollars . . . the correct actuarial amount to cover their care. There needs to be a progressive premium that depends upon their income...pension benefits...investment...everything. Perhaps even taking assets into account.
Yeah. Paul Ryan suggested something like that, and Mitt Romney ran on it. How'd that go over?
We're so screwed up it's pathetic. I personally know two people who are milking a system that allows them to do so. One has over $1 million in assets and is on Medicare's Advantage Plan. He pays $104 a month -- and no more. That's ridiculous. Another who has over a half-million dollars in assets who gets his medication without having to buy Part D for $5 a prescription through a subsidized plan. He pays nothing for the plan itself. Both of these examples are ridiculous. The system needs drastic repair; but the MODEL itself works.
The model is parasitic, and it "works" because it is so. Medicare's reimbursement schedule underpays providers, who then increase the costs they charge to private plans. It also contains massive amounts of fraud, waste, and abuse. It "works" in the sense that "hey, we successfully invaded Afghanistan, so the policy there has 'worked'". Force Medicare into a constrained budget as you are suggesting, and watch what happens every time a government attempts to prove it can operate like a business.
