Medicare Receipts, Medicare Outlays and the Medicare Deficit

Posted by PITHOCRATES - March 5th, 2013

History 101

The Seller is the Medical Provider and the Customer is the Insurer—not the Patient

Health care prices are out of control because there are no market forces in health care.  Buyers and sellers never meet.  As the consumer of health care services doesn’t pay for them.  And the provider of services neither bills nor collects from the recipient of those services.  Instead billings and payments go through a third party.  The insurer.  Or government.

The buyer is the insurer.  Not the patient.  Who is the recipient of what the buyer pays for.  Because the recipient is not paying the recipient does not care about prices.  Or the number of tests and procedures a doctor orders.  Because if you’re not paying what do you care how much anything costs or how many costly tests or procedures you have?  You don’t.

The seller is the medical provider.  The doctor, hospital, laboratory, nursing home, etc.  Their customer is the insurer.  Who pays their bills.  Not the recipient of their services.  The patient.  Because the patient is not paying medical providers can charge high prices without hurting their patient.  And they can order excessive tests and procedures without hurting their patient.  Financially, at least.  Which they often do because medical providers don’t get paid for all the services they provide.  Some people without insurance can’t pay their bills.  And insurers often refuse to pay or discount some of the bills they receive.  Also, the government is always reducing Medicare reimbursements.  Forcing medical providers to be more creative in getting paid for services rendered.

As Medicare Outlays and Receipts grew Further Apart the Medicare Deficit Soared

Medicare began in 1965.  Medical care for people 65 and older.  And like the private health care market there are no market forces in Medicare.  Worse, government bureaucrats run it.  Which throws open the doors to waste and inefficiencies.  And cost overruns.  Because private insurers have bottom lines to meet.  Government bureaucrats don’t.  All they have to do when they do a poor job managing something is to raise taxes.  Which they had to as Medicare ran a deficit in all but one year of its existence (see Table 2.4—COMPOSITION OF SOCIAL INSURANCE AND RETIREMENT RECEIPTS AND OF EXCISE TAXES: 1940–2017 and Table 3.1—OUTLAYS BY SUPERFUNCTION AND FUNCTION: 1940–2017 at FISCAL YEAR 2013 HISTORICAL TABLES BUDGET OF THE U.S. GOVERNMENT).

Medicare Receipts Outlays Deficit 1970-2011

Medicare ran a $912 million surplus in 1974.  We made it zero to keep the Y-axis positive.  The difference in graphs is negligible and unnoticeable at the scale shown.  The right axis shows the Medicare payroll tax rate.  Medicare outlays and receipts are pulled from the above referenced source.  The Medicare deficit is calculated by subtracting Medicare Receipts from Medicare Outlays.  However, for simplicity we show that negative number as a positive value on the graph (the graph shows the magnitude only of the deficit).  The graphs are pretty flat during the Seventies so we drop them off in the following chart.

Medicare Receipts Outlays Deficit 1980-2011

The Medicare tax rate has been holding steady at 2.8% since 1986.  This tax rate has provided a growing rate of Medicare receipts.  But Medicare outlays have grown at a greater rate.  Outlays remained flat for a few years in the Nineties thanks to the Medicare Sustainable Growth Rate (SGR) included in the Balanced Budget Act of 1997.  Which basically discounted doctors’ Medicare billings.  Doctors provide the same services.  Only the government paid them less.  After some fierce opposition this provision (the doc fix) went away.  For it was either that or doctors would leave the Medicare program en masse instead of operating at a loss.  Leaving the government with a lot of seniors without any doctors.  So Medicare outlays resumed their upward growth.  With receipts growing at a lesser rate.  As outlays and receipts grew further apart the Medicare deficit soared.

Obamacare Spending will be out of Control because Medicare Spending is out of Control

The Medicare tax is a flat tax.  Which means the more you earn the more you pay.  Unlike Social Security that has a maximum taxable earnings amount.  The Social Security tax rate is 12.4% of the first $113,700 you earn.  Bringing the FICA tax (Social Security and Medicare) total to 15.3%.  When they passed the Social Security into law they promised that the Social Security tax would never exceed 3% of the first $3,000 you earn.  Just to give you an idea of how horrible the government’s projections were.  They have raised taxes far beyond what they promised and it still isn’t enough.  Medicare is running greater and greater deficits.  So Medicare is in trouble.  And with Obamacare pulling some $700 billion from Medicare things aren’t going to get any better any time soon.

Medicare is national health care.  And the government is running it very poorly.  The Medicare outlays in 2011 were $485.6 billion (or about 13.5% of all 2011 federal outlays).  And that was generated from treating only 12.8% of the population.  How bad will these numbers be if Obamacare evolves into a full-fledged national health care service?  If you divide the 2011 Medicare outlays by 12.8% you get $3.79 trillion.  This amount would be for 100% of the population receiving medical care as if they are 65 or older.  Currently those 65 and older consume about 35% of all health care spending.  So if we multiply $3.79 trillion by 65% (1-35%) we get $2.47 trillion (or about 68.4% of all 2011 federal outlays).  Which adjusts this amount as if everyone receiving health care is under 65.  As the amount of those 65 and over receiving health care will fall under Obamacare thanks to those unofficial death panels.  And they’re going to need those death panels.  Because with the government running Obamacare it will be an abject failure.

A crude guesstimate.  But it’s probably not that far off.  For national health care is very, very expensive.  And as we’ve learned from Medicare, it’s also very, very inefficient.  Because there are no market forces in health care.  Which is why Medicare spending is out of control.  And why Obamacare spending will be out of control.  Requiring massive new taxation.  Rationing.  And cost cutting.  As in death panels.  For letting people die instead of treating them will be the only way to bring down costs.  Unless they force health care providers to work without pay.  Another way to cut costs.  Compel health care providers to work against their will.  For why should anyone profit off the suffering of others?  Which may be the next dictate handed down in Obamacare.

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LESSONS LEARNED #67: “Free health care is very expensive.” -Old Pithy

Posted by PITHOCRATES - May 26th, 2011

Romneycare

In 2007 Romneycare took effect in Massachusetts.  A precursor to Obamacare.  Though not by design.  The new health care requirement included an individual mandate.  You either bought health insurance or they penalized you.  Ditto for employers.  They either provided health care or they penalized them.  It included subsidies to help the less wealthy pay for their mandated insurance.  And added a new and powerful health care regulatory board.  Finally, an example of what compassionate Big Government could do.  And how successful has Massachusetts been in providing free/affordable health care to everyone?  Well, as of 2011, not a single state has followed their example.

It has failed to provide universal coverage.  It has failed to control health care costs.  It has cost more in taxes than originally projected.  Health care has become more bureaucratic.  There is less choice.  Medical bankruptcies went up.  And there’s talk about implementing price controls.  And, of course, rationing.  Everything the critics warned about in a universal health care program.  And everything the proponents poo pooed.  Because those things only happen when everyone else tries universal health care.  But everyone else isn’t them.  They know how to do it right.  And their plan will not only not have those problems.  It will provide universal, quality health care at affordable prices while reining in health care costs without new and higher taxation.  Of course they were wrong.  And the critics were right.

Sound familiar?  The proponents of Obamacare have said the same thing.  In fact, Obamacare is pretty much Romneycare at the national level.  Interestingly, Mitt Romney, the architect of Romneycare, opposes Obamacare.  As a Republican candidate for the 2012 election, he promised to repeal Obamacare.  Probably because if they do at the national level what he did at the state level it would ruin the U.S. economy.  Because nothing went as planned in Massachusetts.  So there is no reason to believe that Obamacare will not be the train wreck Romneycare was.  Even if the ‘right’ people finally take a crack at it.

Medicare

In the U.S., federal tax revenue (i.e., federal income taxes) averaged about 18% of GDP between 1970 and 2010.  So if the government’s budget was balanced, federal spending would also equal 18% of GDP.  When it’s not balanced and they spend more than this 18% of GDP it results in deficits.  Which the government has to finance either by raising taxes, borrowing money or printing money.

In 1970, Medicare outlays were about 0.7% of GDP.  By 1980, that number increased to 1.2% (a 71.4% increase over the decade).  By 1990, it increased to 1.9% (a 58.3% increase over the decade).  By 2000, it increased to 2.2% (an increase of 15.8% over the decade).  Or a total increase of 214% in only 30 years of the program.  And that’s the good news.  The projections are far worse.  By 2020, it will be 3.6% of GDP (a 414.3% increase from 1970).  By 2030, it will be 4.9% of GDP (a 600% increase from 1970).  By 2050, it will be 6.7% of GDP (an 857.1% increase from 1970).  By 2075, it will be 9.6% of GDP (a 1,271.4% increase from 1970).  At which time it will consume more than half of all tax receipts.  And equal the size of the 2010 federal deficit.  And this is for Medicare alone.  It doesn’t include Social Security.  Defense.  Or interest on the debt.

These numbers are huge.  Growing.  And out of control.  It’s the biggest piece of all entitlement spending.    And it’s the biggest single item of the federal budget.  It is without a doubt some of the worse number crunching the federal government ever did.  Not only did actual costs exceed their estimates, they were three times higher in only 30 years.  One thing is clear.  The federal government doesn’t know the first thing about running a health care system.  And yet here they are.  With Obamacare.  Which will be a lot like Medicare.  Only bigger.  Because Obamacare won’t just be for the seniors.  It’ll be for everyone.

Cubacare

To borrow a medical term, Medicare is circling the drain.  It won’t be around for the kids of today.  Unless they enjoy paying a flat tax of 100% of their earnings to continue to fund it and the rest of government.  Of course, that won’t leave anything for food, utilities, rent or the other necessities of life.  In other words, they will work.  But they won’t get paid.  Reduced to involuntary servitude.  Life will be pretty bleak.  But there will be health care for everyone.  But not in the utopian way the government planners are promising.  It will be more like in Cuba.  Where it’s illegal to criticize the government.  So most don’t.  And they abort babies when it looks like they may not live through infancy.  Thus giving them a low infant mortality rate.  A sign of a first class health care system.  But the hospitals are dirty.  And filled with out of date equipment.  Much of which doesn’t work.  And there is a wholesale lack of medicine.  Because they are just too impoverished to buy any.

We have to fix Medicare.  If we want to keep having Medicare.  It can’t stay as it is.  It’s just too costly.  As all universal/free health care tends to be.  And a declining birthrate compounds the problem.  Baby boomers are retiring.  And making the system top-heavy.  The consumers of health care are growing faster than the payers of health care.  What’s worse is that it borrows from one generation to pay for another.  As they tax the young more for today’s retirees the young will have less to save for their own retirement.  So not only will they not have Medicare when they retire, they will have saved less than today’s retirees.  Making their retirement truly a bleak and impoverished picture.  How bleak?  Cuba bleak.

And continually raising taxes isn’t the answer.  Because there’s a limit to how high you can raise taxes.  Massachusetts has apparently reached that limit.  For they are now considering price controls and rationing.  Which will make things worse.  Not better.  The UK and Canada are in earlier stages of price controls and rationing.  Cuba is in a much later stage.  And you can see the progression of quality.  Of these four countries, which would you choose for your health care needs?  Most probably would choose the United States.  Many, though, no doubt, would choose Canada or the UK.  But one thing for sure.  No one would choose Cuba over the other three.  Sadly, based on the numbers, that’s where Medicare is heading.  Of course, it probably won’t ever be like Cuba.  For it probably will cease to exist long before it gets that bad.

Costs will Continue to Rise

If we learn anything in life it needs to be these two things.  Nothing is free.  And government is horrible at running things.  Providing quality yet affordable health care to everyone are two conflicting goals.  You can provide high quality health care.  But not to everyone.  And you can provide health care to everyone.  But it can’t be high quality.  Universal health care, because of its cost, has to make limited resources cover more people.  That is to say, they will have to ration resources. 

When the government is picking up the tab for health care, there will be no more private rooms in hospitals.  Or semiprivate.  There will be crowded wards.  So doctors and nurses can carry higher patient loads.  To keep costs down.  And to allow fewer resources cover more people.  They will ration high-cost treatments.  Not everyone will get dialysis.  Or chemotherapy.  There will be fewer machines.  And less medicine.  Because of costs.  Only the few meeting the government’s criteria will get these treatments.  Or those with pull.

Even then the costs will continue to rise.  And the more the government takes over, the more health care costs will be transferred to the taxpayers.  Who will pay ever higher taxes.  And get ever less in return.  But they will have universal health care.  It will just be horrible.  As their lives will grow to be.

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