Solution 1B) Entitlement Reform – Social Security, Medicare and Medicaid

"Well now your back's going to hurt!"

So here is where the hard part begins when I specifically start talking about entitlements.  Before I begin on how to actually fix them, I must point out two oxymoronic aspects of entitlements in general.  The first is that everybody is generally for a getting the nation’s fiscal house in order by fixing the budget and the deficit.  Everyone generally knows that the government spends too much, even if it admittedly does a poor job at collecting taxes from entities that should be paying them.  Secondly, everyone generally also knows that it is the big three entitlement programs (Social Security, Medicare, Medicaid) are really what imperils our nation fiscally.  The liabilities in the future for the same level of care and money provided to more and more aging baby boomers is completely unsustainable.  Why then, does everyone know these two facts but just continue to stick their head in the sand?  The longer you wait, the worse the problem will get!

With that set of observations out of the way, I am prepared to tell you the hard, ugly truth about entitlements.  It is not meant to be offensive, critical, or an attack.  This is simply the blatant truth.

Entitlements create the false choice of promising something this nation, as great as it is, cannot deliver.  Every year, we spend more and more money that we do not actually have on an elderly population that has a disproportionate sway on government (because they actually vote unlike other demographic groups – but good for them!) and that money/healthcare is seen as a something the elderly population is entitled to collect.  That money goes to a generally unproductive strata of society that was over-promised a system of support in their waning years and underpaid into it due to bad government programs and policies of the past.  It hurts to say it but its true.  Its also highly unpopular and not fair to just pull the plug on Grandma.  Meanwhile, that same money that is keeping her alive but giving her years of sub-standard quality of life standards at a retirement home could have been reinvested in education, energy development, infrastructure, or co-opting domestic business development; all things that yield a return on the money spent.  Outside the fact that some of the money is spent outright on consumption in this consumption-drive economy, money spent on entitlements just goes up in smoke .  This is not to say that we leave the elderly on the streets, but it is a painful amount of federal and state monies being spent on the past, not the future.

The problem and difficulty with entitlements is that it is really, really easy to promise something that was cheap 40 years ago, but really hard to pay for it today or claw it back when the expenses have greatly gone up.  The rules have changed.  People are living longer, more complex medical procedures cost more and then they keep people alive longer as a form of double whammy.   A great example of how things have gone awry is the Social Security retirement age.  Social Security benefit ages have not risen as fast as life-expectancy in this country.  FDR’s administration originally designed it with an age bracket in mind that most Americans never lived to see.  Many paid into the system, but didn’t collect from it.  That is how it was sustainable.   Society today is also far more likely to ship parents and grandparents off to the expense of a home rather than have the ‘burden’ of them living with family once they get too old to take care of themselves.  Hence, the tax-payers pay for the greater cost of care than the cheaper alternative of the elderly staying with family…even if further subsistence payments were available for family-based care.

The same general principle can be applied to health-care for the poor.  “It’s not my money, it’s the governments so why do I care?”  Well it is your money in a very direct sense every April 15th.   Indigent care, unneeded ER visits, and other forms of “disinvested” spending are ways that great sums of money are wasted.  And that is a problem my friends – we spend way too much money to get substandard results of an impoverished elderly class, expensive health-care, and a culture of dependency in welfare.

My statements do not mean that the poor should die in the streets, that the elderly should just hurry up or die, or that you have to pass a ‘contributing to society test’ in order to get help should you fall on hard times.  My statements are aimed at how we strive for noble social goals to take care of our most vulnerable citizens and we yer fail both them and our future citizenry grandly by continuing to contribute to the fraud, waste, and abuse of the current system.  Good enough just won’t cut it much longer.

The Solution(s) –They are actually very hard, but amazingly simple.

1) The first and the greatest is the solution I proposed to make medical care cheaper and more effective from the previous article.  By following that program, you lower everyone’s costs and it makes it a lot cheaper to care for the elderly, the poor, and everyone in between.  That right there has a direct effect on how wealthy a person actually is from the social security check when only a fraction (instead of 2/3rds) goes to prescription, co-pays, and medical charges.  And obviously, cheaper healthcare means cheaper Medicare and Medicaid costs.

Such reforms only get us treading water however.  There are still too many promises and IOUs in the accounts of these programs.  Instead of making a patch that will last for 25 – 30 years, like the US did in  1983 for Social Security before it needs to get fixed again, lets put the problems to bed once and for all.

2) Social Security:  Raise the retirement age.  Early retirement 64-66.  Standard retirement 66-70.  Delayed retirement 72-74.  Something like that.  I purposefully put a range in as this is nt supposed to be hard and fast, but give you an idea of what I’m thinking.  You see, there is some misconception in this country that you work for X years and then you don’t have to anymore.  THE WORLD DOESN’T WORK THAT WAY IF YOU DON’T PROACTIVELY SAVE FOR THAT DAY.  Solely depending upon social security is what keeps over 40% of our elderly citizens out of poverty…and even then it’s not like they have a lot of money to work with.  This country needs to get off the mindset that someone will be there to take care of you, so you don’t have to make financial sacrifices now in the form of an IRA or a 401(k) to ensure your financial security in the future.  Too few people save and its the savers who get punished by low interest rates (like today’s environment) or possibly later.  All it will take is Congress’s writ and things like ROTH IRAs could be taxed despite already being taxed as regular income when the money was deposited.  Platitudes like ‘shared responsibility’ and ‘helping your fellow American’ are all to easily thrown out when times are depression level tough and money has to be raised.  While this is mere conjecture, look at the current batch of charlatans in Congress, look yourself in the mirror, and try to lie to yourself and say they wouldn’t do it today if push comes to shove.

Lastly, if you’re one of the lucky few who have a retirement program, good for you…but you are in a dwindling minority.

3)  Social Security:  After a certain lifetime income, benefits decrease until they are gone altogether.  Call it a ‘success tax’ if you will.  This program doesn’t affect the middle class or even the well-to-do, but the actual truly wealthy people in this nation who have millions in brokerage accounts, have yachts, a home in the Hamptons, and in retirement, could maintain a middle class existence on the interest payments from their assets alone.  These guys don’t need the help of the American tax-payer.  Yes, they paid into a system they never get to benefit from…but they did benefit – from ree market, American style capitalism.  Their success, their profits, come from the people whose hard work made them money and their wages bought their products.  They directly and indirectly benefitted from people who were monetarily less successful than them but buoyed their success.

4)  Medicare:  Make the free market the cost standard – not the other way around.  Today everything is based upon what Medicare bills.  In my solution from the previous article, it is the market…and that is what medicare pays.  It is just another way to dampen bubbles and pay fairly for services as Medicare would still be a large buying block of patients in any market.  The rest of solution 1 addresses the directly reduction of Medicare costs.

5) Medicaid as a subset of the welfare system:  It’s the carrot or the stick.  The truly poor, helpless, underaged, and defenseless sectors of society need to be protected no matter what, no strings attached.  Solution 1 at least makes it cheaper.  However, there is a portion of the populace that abuses the system, to include their health care.  They choose to be ‘poor’ because it actually enriches them.  Why work at a crappy job, make $400 a week and have to pay food, rent, day-care, and health insurance costs and not have ends meet because you are lazy and have no other opportunities for employment other than working at a McDonalds when instead you can be on welfare, do nothing, and get food stamps, WIC, child-based welfare checks, and a Medicaid card?  Then you may only get a check for $300 a week, but its all discretionary as the government pays the rest of your bills?  A self-interested person would of course choose the second option, especially if they have no qualms of not contributing to society.  The welfare state for the unworthy and the willingness to take advantage of it are both un-American and I take a very dim view.  We need both the carrot and the stick.  Those who can’t pass drug tests, keep jobs, and generally be contributing members of society despite being able-bodied need to be cut off.  It is not government’s responsibility to subsidize their sloth.  However, if we are to take such a hard approach, we must have a carrot as well.  Workers must be given a living wage.  This is a combination in  a raise in minimum wage, a reduction in costs of life’s necessities where possible (food, energy, etc – I’ll cover in another segment), and more investment in social services that teach job skills, place jobs, and dust people off and get them back on their feet.  If they are willing to work hard and contribute, then the welfare system is working how it should.  This section was much larger than just Medicaid, but that program is a subset of a much larger issue that is hard to separate Medicaid from, so I covered the major points while admittedly going off topic.

Finally, I don’t admit to having all the answers.  I probably have more in my head and there are more out there.  This article was designed to give you some specific solutions, but also take 3 steps back and evaluate entitlements and how they are viewed in general.  If you can come at them from a fiscally sustainable obligation that is fair while not stealing from the future of the next generation of Americans, then you’ve arrived at the same conclusions I have.

– G.S.

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