President Obama has won reelection, and his administration has asked state officials to decide by Friday, November 16, whether their state will create one of Obamacare's health-insurance “exchanges.” States also have to decide whether to implement the law's massive expansion of Medicaid. The correct answer to both questions remains a resounding no.
The wind and rain from Hurricane Sandy hadn't even stopped before some people argued that the storm made the case against reducing the size of the federal government or giving states more say in their affairs. The federal response to a crisis became the proxy for big government in all its bureaucratic glory. Cutting government, we were meant to understand, means letting Sandy's victims fend for themselves.
Back in August, Cato adjunct scholar Veronique de Rugy expressed concern about Republican campaign rhetoric on Medicare. As Republicans tell it, they want to “protect” and “strengthen” Medicare, whereas President Obama wants to “cut” and “weaken” it. Veronique thinks that the GOP’s “Mediscare” campaign could end up backfiring by making it harder to reform Medicare if Republicans succeed in taking control of Washington.
Today’s New York Times features an opinion piece by J.D. Kleinke of the conservative American Enterprise Institute. Kleinke’s thesis is that ObamaCare’s conservative opponents should stop complaining. “ObamaCare is based on conservative, not liberal, ideas.”
Government subsidies often produce unintended consequences. The latest example comes from the New York Times, which reports that federal subsidizes to encourage doctors and hospitals to use electronic billing and recording records are leading to larger Medicare bills. That means that taxpayers are taking a double hit even though policymakers claimed that electronic record-keeping would make health care delivery more efficient, and thus less costly.
In the Obama campaign's attack on the Romney-Ryan proposal to “voucherize” Medicare, one accusation is that the plan would force seniors to pay more of their healthcare costs: about $6,400 more per beneficiary, according to a recent TV ad known as “Facts.” Regardless of the “facts” in the ad, this attack takes as a given that any such outcome is undesirable.
Let's try to put the ongoing debate over the future of Medicare into a little bit of context. Last year, Americans paid $274 billion in Medicare taxes and premiums. At the same time, the program paid out $564 billion in benefits. That amounts to a shortfall of roughly $290 billion. Looking into the future, even the most optimistic estimate by the program's trustees puts Medicare's future unfunded liabilities at more than $38.6 trillion. More realistic projections suggest the shortfall could easily top $90 trillion.
A study in this week’s New England Journal of Medicine finds that when three states expanded their Medicaid programs, mortality rates fell 6 percent relative to four neighboring states. The study found evidence that the mortality gains were concentrated in poorer counties — i.e., where people were most likely to become eligible for Medicaid.
The Washington Post reports that a doctor in Texas bilked Medicare and Medicaid out of $375 million. That’s a lot of money, but improper payments represent somewhere between 10 and 20 percent of total spending on these two health programs. Thus, more than $100 billion of taxpayer funds could be going down the drain each year.
Medicare and Medicaid are rife with fraud. We’re talking 10 percent or more of total spending, which is two orders of magnitude more than what credit card companies tolerate.