Why Medicare Finances are Such a Big Driver of the National Debt

As the readers of this blog well know, I am highly concerned about our country’s rapidly growing and out-of-control national debt.  Furthermore I have pointed out many times that the main driver of our debt is the excessive cost of healthcare, both public and private (Medicare, Medicaid and the tax exemption for employer provided health insurance).

In a recent post I showed that the high costs of American healthcare are due to high prices for healthcare products and services (hospitals, doctors and drugs), the complexity of the U.S. health insurance system and the rapid growth of healthcare administrative staff.

In my last post I proposed first of all, to use the Medicare price structure to set a cap on the price of all medical services and secondly, to figure out how to better fund Medicare itself.

Today I present an analysis of Medicare finances based on a recent report by the Kaiser Family Foundation.  Consider:

  • Medicare Part A is financed primarily from a 2.9% payroll tax. Medicare recipients only pay about 25% of the costs of Parts B (providers) and D (drugs) through monthly premiums, deductibles and copays.  Overall, 41% of Medicare expenses are paid by the federal government (see first chart).Capture45
  • In 2017, net federal spending for Medicare ($591 billion) represented 15% of the federal budget (see second chart).Capture43
  • The Congressional Budget Office projects net Medicare spending to increase to $1.3 trillion in 2028 or 17.9% of the federal budget (see third chart). It will increase from 2.9% of GDP to 4.2% of GDP over this same time period.Capture44
  • This rapidly growing federal share of Medicare costs is not being adequately paid for and is therefore adding dramatically to federal deficit spending. Options are to raise the payroll tax for individuals, shift Medicare from a defined benefit structure to a premium support system or increase federal tax rates.

Summary.  Medicare is an efficiently run healthcare system but is currently underfinanced by over one-half trillion dollars per year and growing.  This is a major contributor to our rapidly growing national debt and will cause a huge new fiscal crisis if not addressed.

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