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Will the next President tackle the Medicare crunch?
By Lauren | June 6, 2008
In a recent posting on ethical issues facing the next President, I talked about generational accounting and the whopping tax burden that today’s citizens are piling up for future generations. To be a little more specific, let’s talk today about one of the largest elements of the looming debt: the rising costs of Medicare and Medicaid.
We live in an age of medical miracles, when lives and limbs that once would have been forfeit are now routinely saved. People are living much longer than they once did; it’s a little-known fact that, when Social Security was first put into place, Congress chose 65 as the standard retirement age because that’s the age when most wage-earners passed away. Now, living to 100 or more is so common that it’s difficult for Willard Scott to get through his daily list of birthday wishes on the “Today” show. The longer people live, the more expensive their medical care tends to become, and the quality of care we’re now able to provide comes at a hefty price tag.
Medicare’s trustees have assumed that cost growth in the Hospital Insurance Program (otherwise known as Medicare Part A) will start to slow in twenty-five years or so, and will come into line with the Gross Domestic Product growth rate sometime in the 2080s. The trustees may be right about that, and about their estimate that the Medicare program is only slightly underfunded. Other commentators are less optimistic, though; for example, in a paper published by the National Center for Policy Analysis, generational accounting gurus Jagadeesh Gokhale and Laurence J. Kotlikoff argue that unless, we see a change in elderly entitlement programs in the next decade or two, future taxpayers could face lifetime tax rates of up to 63% of their income.
Ouch!
One way to cut Medicare and Medicaid costs would, of course, be to raise deductibles – for seniors living on fixed incomes, that’s hardly a palatable choice. More draconian measures might include raising payroll taxes and either cutting or even denying certain benefits. If that happens, though, tough ethical questions are bound to arise. Should Medicare deny or limit coverage to an elderly patient whose already long life could possibly, but not certainly, be further extended by an expensive medical procedure? Should Medicaid benefits be provided to some patients but not others and, if so, who should take priority? Would it be ethical to refuse available medical care to patients who would benefit from it? Would it be ethical to provide that medical care at a crushing financial cost to future generations? If care is going to be limited or denied, who should have the power to make the hard choices, and what criteria should they use?
Would your Presidential candidate have the courage to take this issue on? If so, what would he do, and are you comfortable with that? You decide.
Topics: Presidential Campaign, Social Ethics, ethics |
June 6th, 2008 at 6:48 pm
I especially like these posts about the presidential election. It is better by far to deal with real issues rather than talk about “family values” or “patriotism” or the latest fear trend. 63% tax rates and end-of-life decisions made on cost are stark ethical issues. Thanks for this series.
June 9th, 2008 at 2:40 am
Hi Chris,
Thanks! Glad you’re enjoying it.
Best,
Lauren