Jewish World Review Dec. 26, 2003 /1 Teves, 5764
Drs. Michael A. Glueck & Robert J. Cihak
Medicare Bankrupt: A Possible Palliative
Nearly everyone agrees: In its present form, Medicare is doomed to
Within this unanimity, however, are three very different points of view.
The Leftists and socialists among us want it to happen, in order to force a
complete government takeover: To borrow an old Vietnam analogy, "We had to
destroy the system in order to save it."
Meanwhile, some political conservatives - especially those Republicans
facing re-election next year - shrug it off with the Enron attitude: "When
insolvency is inevitable, make the most of it."
Thirdly, most Americans go about their business with a kind of Scarlett
O'Hara "I'll think about that tomorrow" resignation.
Let's think about it today. Specifically, let's consider a proposal put
forth by Philip R. Alper, M.D., the Robert Wesson Fellow at Stanford's
Hoover Institution. Dr. Alper suggests that Medicare become, at least in
part, a "wealth-based loan program." This reverses the pre-1965 practice of
"means testing," which required virtual indigence before admission to
government health care programs.
No one suggests this would be a complete solution, but it would help break
up the "one size fits all" logjam that currently dominates thinking about
the Medicare program. Congress and the president include some premium
increases for higher earners for Part B coverage, the non-hospital part of
Medicare, in the recent changes in Medicare law.
Alper's proposal also deserves serious attention because of who wouldn't
want it under any circumstances: the Left. At first this might seem
After all, aren't leftist liberals at their happiest when "progressively"
soaking everybody? Yes, at least those in the "Equality uber Alles" crowd,
those who desire to force the American people into a "single payer" system
where everybody ostensibly gets exactly the same treatment, namely, what the
government decides to give you.
Of course, the Left doesn't argue it this way. By their reckoning, absolute
equality will cause the nation to demand ever-higher levels of treatment,
which the politicians and the bureaucrats will of course be happy to
Leaving aside the minor issue of how to pay for providing everything for
everybody at the highest possible level of excellence, this argument
suggests that the best way to improve things is through lack of competition.
Should you care to watch this principle of non-competitive efficiency in
action, just contemplate today's Pentagon or the Post Office in the days
before UPS and FedEx brought competition to the parcel part of their
But back to Dr. Alper. In an unpublished paper, he notes that general taxes
rather than Medicare premiums currently fund most of Part B, the
non-hospital part of Medicare. Therefore, the less-affluent elderly and the
tax-paying disabled "inappropriately contribute to inheritance protection
for the rich." Also, under today's system, current revenues are spent on the
elderly, with younger workers also paying for this "inheritance insurance"
through the Medicare tax levied on their paychecks.
In other words, the current system helps the rich stay rich at the same time
it makes the poor poorer.
Hoover economist Thomas Macurdy, writes Dr. Alper, "believes that some form
of means testing is inevitable if the program is to stay solvent and within
the financial reach of its recipients."
Under Alper's proposal, the extra charges would apply only for care actually
received. One payment option would a life-long loan paid off by the estate
of Medicare recipients after death. This would protect seniors' way of life.
This is an intriguing idea that would buy some time for Medicare, giving an
opportunity for attitudes about Medicare and health care to change while the
implications of the health savings account (HSA) provision of the new law
sink in. [See: Silver Lining in the Medicare Clouds?<]
As Alper writes, in a different context, "The answer does not lie in more
rules and regulations and more interference with the freedom of both doctors
and patients to do what they think best."
With such changes, additional reforms allowing enhanced individual choice
and responsibility for both patients and doctors could again be taken
seriously. Partially "opting out" of the system would likely be more
acceptable, in contrast with the current "all or none" strictures on
participation in Medicare.
True, there is always some risk in any change; in this case, legions of
bureaucrats would have to write regulations implementing such changes,
adding to the already impossible burden of compliance.
And it doesn't take prophetic abilities to know that legions of civil
lawyers would descend on the whole "loan good until death" system; that
endless loopholes and endless lawsuits would trash the equity as well as the
But now that the bulwark of the "one size fits all" entitlement mentality
has been breached, this idea deserves serious consideration.
Editor's Note: Robert J. Cihak wrote this week's column.
Michael Arnold Glueck, M.D., is a multiple award winning writer who comments
on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute
Senior Fellow and a past president of the Association of American Physicians
and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists.
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