Monday, September 16, 2013

On the Ridiculous Notion that Medicare Can be Saved Strictly by Raising Taxes on the Wealthy

You could tax everything over $100,000 at 100% and it wouldn't even come close to funding the trillions in unfunded liability. That, and it would only be a one-shot deal in that nobody in his right mind would ever want to work for $500,000 a year if $400,000 of it was going to skimmed off immediately. The fact of the matter is that Medicare needs to be reformed COMPLETELY (via the insertion of strong market forces) and, until it is, it will literally be nothing more than a Ponzi scheme.

15 comments:

Les Carpenter said...

Will, why bother anymore? Just take it all in and enjoy the ride until it all comes crashing down. The horses, cows, pigs, sheep, chickens, and whatever else are already out of the barn and running wild.

dmarks said...

Remember WD. Mom-and-pop store operators are plutocrats, too.

Let's say we tax 100% of everything over $23,000. Nail all of those plutocrats! Do you think we might fix the unfunded liability then?

Rusty Shackelford said...



How about tort reform?

Will "take no prisoners" Hart said...

If it's the type of tort reform that significantly reduces defensive medicine then, yeah, absolutely.

Rusty Shackelford said...


Exactly Will......and eliminate the John Edwards of the world.

dmarks said...

Rusty: And people who choose to spill hot coffee on their lap and contrive to abuse the court system to get innocent people to pay to make them rich will go to prison. Alongside the Edwardses.

Marcus said...

Will: There are other forces that are derailing Medicare. Additional tax dollars might help but Fraud is a huge problem. That and the health care industry is milking the system by adding un-needed treatments to patient care, e.g., why would a 90 year person get a knee replacement surgery or terminal patients receive physical therapy? Why are terminal patients receiving heroic treatments that will not save them? Apparently this happens a lot and we discussed this a some length. Maybe at a certain age we should receive rationed care but I guess that's considered "death panels" by some folks. IMO if Medicare is a "Ponzi" scheme it doesn't have to be...Try tightening things up a bit and then ask for folks to pay a little bit more for their care (if they are in a position to do so.)...a pin prick along with a very marginal tax increase. Is this such a radical thing???

dmarks said...

"Maybe at a certain age we should receive rationed care but I guess that's considered "death panels" by some folks"

Rationed care IS death panels, and it is scary as hell. The answer is a resounding "NO" to that. It is one reason I strongly oppose any centralization or "single payer" of healthcare: to minimize the damage done when the powers-that-be decree that some people are worthless and don't deserve care any more. Then you end up with something like the hospitals in the Netherlands killing kids deemed "worthless".

If we decentralize, than public sector OR private sector bureaucrats who decide to intentionally kill people (through improper or withheld care) for a brave new future will have a lot less power.

Sorry, I think that 90-year-old deserves care as much as a 30-year-old. I don't go around placing value on people like that. It's scary as hell.

Will "take no prisoners" Hart said...

I don't have a problem with any of your suggestions, Marcus (and I tend to agree with you on the topic of Ms. Palin). I just think that the demographic time-bomb which is currently just around the corner is going to make it exceedingly difficult to bend the cost curve absent some major reform. Of all the current possibilities, I think that the compromise that Ryan and Wyden came up with is probably a good enough start.

Will "take no prisoners" Hart said...

dmarks, I don't think that Marcus is saying that 90 year-olds shouldn't receive treatment, just that the treatment should be appropriate (a 90 year-old probably couldn't survive a knee replacement surgery anyway) and have a benefit. I work in a convalescent home and there is a whole lot of what I consider soft fraud (therapist trolling for things that they could bill Medicare for, using up all the allotted visits even if they aren't necessary) and a whole lot of unreasonable expectations by family members who refuse to let go. I don't know what the absolute answers are but a frank discussion is clearly needed.

dmarks said...

That 90 year old with the knee replacement could very well live 11 or so more years, while the 30 year old with the knee replacement could get creamed by a drivetexter when crossing the street the day after she gets out of the hospital....

He is right about the fraud, and the rest was not intended as a personal attack against him.

Marcus said...

Will: Thanks for your support...Just to be clear, rationed care does not mean the government or society is placing a "value" on the elderly or the terminally sick...it's about offering practical care that is best option in a particular situation for a particular patient. This is a pragmatic approach rather than one based on partisan ideology. It has nothing to do with centralization vs. decentralization... The process of dying is something everyone faces...it might worth doing an academic study on the last 10 years of life. We could learn something about aging, and the process of dying. Maybe it would lead to useful and ethical solutions in Medicare administration.

Will "take no prisoners" Hart said...

Marcus, from my experience, I would say that the majority of the families ultimately do do the pragmatic thing but, yes, there are clearly those that don't. And it isn't just a waste of money, it can also be very cruel to the patient (putting them through uncomfortable and, if they have dementia, sometimes scary procedures) involved. Yeah, we definitely need to examine this more.

dmarks said...

I disagree. Centralized vs decentralized is very important in this. The more centralized, the worse the problem of authorities forcing a supposedly "pragmatic" approach on families and patients.

I believe it does get right down to "rationed care" meaning that "the government or society is placing a "value" on the elderly or the terminally sick", as rationing places a limit and encourages cost savings by reducing care. It makes those in charge look for places to cut.

Will "take no prisoners" Hart said...

dmarks, I obviously agree with you on decentralization (my proposal of health savings accounts and catastrophic care provisions not only minimizes the role of government, it also minimizes the role of insurance companies). I also agree with you that the elderly should be treated as well as the rest of us. But what Marcus and I are talking about are terminally ill people with 6-8 weeks to live, and of how some doctors and hospitals are ordering these expensive diagnostic tests (MRIs, cat scans, barium swallows, blood work, etc.) that will literally not add one second of life to the patient and in certain instances will cause them discomfort. If Medicare is ever to survive in its present makeup, this type of abuse will totally have to end.