Health care reform in 2 short sentences
July 20th, 2011 by 
David E. Williams of the Health business blog
Foes of the Patient Protection and Affordable Care Act (PPACA) made a big point of complaining about the length of the bill. Personally, I think that criticism is unfair, because the law deals with a complex industry that’s almost one-fifth of the economy.
But today I read a brilliant two-sentence proposal in the letters section of the Wall Street Journal from David J. Gross, a Florida dermatologist. He was reacting to an article about the extensive cardiac care received by former vice president Dick Cheney.
Before any of Dick Cheney’s heirs get a nickel from his estate, Medicare should be reimbursed for the difference between what it paid out versus what he paid in all these years. This same paradigm should apply to all of us.
(Actually the essence is expressed in just one sentence.)
If we actually implemented that solution it would have significant salutary effects:
- Make Medicare financially viable for the long run
- Improve inter-generational equity
- Instill cost consciousness in Medicare beneficiaries, thus keeping a lid on expenses
- Reduce the need for an estate tax
Of course this proposal would have drawbacks and unintended effects:
- It would cause Medicare recipients to spend down or gift their estate. This phenomenon is well known among patients trying to qualify for Medicaid payment for nursing homes
- It would penalize those who are sickest
- It might cause people to avoid needed care, harming health and ultimately driving up costs
- In some families, it might lead to tensions among the generations
- The rules to actually implement such a system would be lengthy in any case, so a simple solution would turn into a complex one
On balance I think this proposal deserves some serious consideration. Maybe a modified version, e.g., a 10 percent repayment could be tried at first
Posted in Policy and politics | 
6 Comments »
July 21st, 2011 at 10:07 am
Kevin Drum of Mother Jones wrote about a similar idea idea in an article “Why Not Let the Dead Pay for Medicare?” Basically, keep a running total for accounting purposes then bill the estate after death. In theory that is how Medicaid nursing home care is supposed to work.
He raises a good point. Why should taxpayers provide seniors with a subsidy worth hundreds of thousands of dollars just so aging Baby Boomers can leave a similar amount to their children?
I blogged about it here: http://healthblog.ncpa.org/why-not-let-the-dead-pay-for-medicare/
July 24th, 2011 at 2:49 pm
Nice idea. Too bad Cheney’s care was not provided by Medicare. Sort of blows a hole in the argument.
Also, should estates get refunds for people who paid in more than they received in care?
July 24th, 2011 at 8:29 pm
Alan,
Thanks for commenting.
The Cheney article touched on health care policy and the fact that much of US health care is financed by the feds. Plenty of well-off seniors rely on Medicare to get the kind of care Cheney got.
And yes, it might make sense to give estates a share of the savings from Medicare for particularly inexpensive patients.
July 26th, 2011 at 4:08 pm
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