Saturday, April 13, 2013

Let the Means Testing Begin - Sebelius Proposes Medicare Changes

I have always felt that means testing for Medicare and Social Security was inevitable.  Liberal groups have opposed the idea because means testing changes the entitlement programs from covert wealth redistribution schemes to overt wealth redistribution schemes. Liberals believe being overt, i.e. "transparent" about the wealth transfer would undermine popular support.  To which I reply, "Great, who cares?"  The programs are going bankrupt, popular support or otherwise, making them less important to the social fabric of the middle class, especially upper middle class will allow for some sensible discussion of further reform.  A recent letter to the NYTimes captures the liberal thinking quite well.
Social Security is our most successful antipoverty program, more successful than any welfare grants. Medicare is our most successful medical care program, more successful than Medicaid. In each instance the program available without means-testing works better, without stigma and with general approval and political support. Means-testing turns applicants into potentially fraudulent beggars for charity.
. . .
Entitlements without means-testing unite us into one country. Means-testing divides us into rich and poor, each resenting the other. Our tax system is a much more effective mechanism to deal with disparities in wealth and income.
The letter was responding to an Op-Ed piece by Yuval Levin discussing how the two programs might be means tested.  While I quibble with some of the particulars, I don't see any other long term solutions.

Right on cue, the administration's budget for HHS contains the following gem:
President Barack Obama’s plan to raise Medicare premiums for upper-income seniors would create five new income brackets to squeeze more revenue for the government from the top tiers of retirees, the administration revealed Friday.. . .“Means testing” has been part of Medicare since the George W. Bush administration, but ramping it up is bound to stir controversy. 
The plan itself is complicated. The bottom line is not: more money for the government. 
Obama’s new budget calls for raising $50 billion over 10 years by increasing monthly “income-related” premiums for outpatient and prescription drug coverage. The comparable number last year was $28 billion over the decade.

Inside the details of the plan are increases in premiums and a freeze on adjusting income brackets for inflation.  It is interesting to me only that the administration is floating this idea with little fanfare.  House Budget Chair Paul Ryan is asking Kathleen Sebelius for more details of the plan.  My hope is that this gets more publicity, so the nation starts to realize that we can really only afford to pay for medicare for the poor as part of a welfare program.

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