More on the Ryan Plan, Medicare, and the 'Death Tax'

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I mentioned yesterday Merrill Goozner's contention that Rep. Paul Ryan's "serious" plan to undo Medicare should be considered the real "death tax." Now, some readers' views.

From reader AS:

>>We [already] have that de facto "death tax" in connection with nursing care.

Every family that doesn't have a spare 100k/year effectively rolls the dice regarding how much of an estate may be eaten up by nursing care at the end of life. The only private remedies are 1) LTC [long-term care] insurance, a highly uncertain and problematic product, and 2) strategies to offload assets to children while there's still time.

Perhaps this system is the best we can do right now. There's certainly no will in the U.S. to tax ourselves to the extent that would be needed to provide something like universal LTC coverage. (In an ideal world, how about this bargain: a massive [by US standards] estate tax earmarked for LTC coverage.) But as you suggest, adding near-complete exposure to medical expenses for the elderly would make this risk burden intolerable. I can't believe we're seriously considering it. And in fact, we're not (unless we get a GOP president and Congress before the party changes course...)<<

From a reader with similar experience:

>>Medicare provides a cushion from insolvency only in certain circumstances. If one has cancer or is hit by a truck, it's great. However, if one has Alzheimer's...tough luck.

My Mother had Alzheimer's. In a few short, but excruciatingly painful years, her total nursing home care consumed just under the $250K she had hoped to pass on to me.

I also had to refund MediCal, and pay accumulated legal fees from her trusteeship, another $25K, and was forced to sell the home she was able to pass on. Fortunately for her, she had no understanding of this happening, but the consequences for me and my children have been significant. We need an expansion, not any contraction, of what Medicare will cover..<<

From GP, a scientist:

>>Imagine the tax on a Dr's office staff to manage billing to 23 different insurance plans. That's how many different billing systems my immunologist's receptionist deals with.

My ENT stopped taking anything but Medicare and cash.  He said that his staff was overwhelmed with learning the intricacies of dozens of plans when he decided enough was enough. Medicare doesn't reimburse the most, but billing is simple and they pay promptly. The same cannot be said for private, for-profit insurers. He did the cost benefit analysis and he's been running his practice this way for 2 years.<<

Another reader:

>>Here is what I see happening if the Ryan plan is adopted:

1. As you note, trying to purchase insurance upon retirement will be prohibitively expensive. I'd guess $25,000/ year for a healthy 65 year old. For someone with health problems or pre-existing conditions, impossible. How much of this will vouchers cover? Very very little.

2. Workers will negotiate-like-crazy to have employment-based health insurance extend into post-retirement years. This type of policy will be much more expensive than current plans, to be payed for by employers and workers. Not good.

3. The elderly will die really fast, and use emergency-room healthcare.<<

From an American working in the Middle East:

>>The most obvious question out there for Americans outside of the USA discussions, is "whatever happened to the more liberal version of Obamacare?"

As I understood it, the critical thing about the original White House health care proposal of last year (from the macroeconomics point of view), was to create a govt-managed alternative to private health care insurance, in order to create competition against the private sector and force them to keep rates low. In the polemic that followed, the false accusation of "death panels" arose to kill the initiative, and eventually Obama/Dems had to concede defeat and come up with a more lukewarm version. Which meant abandoning the "government alternative" [aka "public option] proposal. I recall at that time that some economic critics were pointing out that this was the most critical shortcoming in the compromise Obamacare solution, in that it failed to take the opportunity to cap the steady escalation in health care expenses.

We're now a year later and debate is SURPRISE coming up about escalating health care expenses, while in the meantime everybody seems to have forgotten last year's original "government health care alternative in order to cap the expenses". How can that "I told you so" point be brought to the public debate now?<<

Also, from TC:

>>Like yours, my father was a physician. Private practice in Southern California from about 1968 to 1973, then working for a Federal clinic until the big social welfare cuts in Reagan's first term, and then again in private practice in rural Oregon until his retirement a few years ago.

Like many others my father also took notice have when and where medical dollars were spent and to what effect, and I remember about 20 years ago he offered a novel solution to the cost of "dying American style" and it's implication for an aging population.

My father suggested that a elderly person could take a buy out, at (just guessing at a number) 50% of their actuarial benefit. They could travel the world, give to charity, leave to their descendants, or even spend all or some on the cost of dying.<<

After the jump, a dissenting view and a reply.

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James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. His latest book is China Airborne. More

James Fallows is based in Washington as a national correspondent for The Atlantic. He has worked for the magazine for nearly 30 years and in that time has also lived in Seattle, Berkeley, Austin, Tokyo, Kuala Lumpur, Shanghai, and Beijing. He was raised in Redlands, California, received his undergraduate degree in American history and literature from Harvard, and received a graduate degree in economics from Oxford as a Rhodes scholar. In addition to working for The Atlantic, he has spent two years as chief White House speechwriter for Jimmy Carter, two years as the editor of US News & World Report, and six months as a program designer at Microsoft. He is an instrument-rated private pilot. He is also now the chair in U.S. media at the U.S. Studies Centre at the University of Sydney, in Australia.

Fallows has been a finalist for the National Magazine Award five times and has won once; he has also won the American Book Award for nonfiction and a N.Y. Emmy award for the documentary series Doing Business in China. He was the founding chairman of the New America Foundation. His recent books Blind Into Baghdad (2006) and Postcards From Tomorrow Square (2009) are based on his writings for The Atlantic. His latest book is China Airborne. He is married to Deborah Fallows, author of the recent book Dreaming in Chinese. They have two married sons.

Fallows welcomes and frequently quotes from reader mail sent via the "Email" button below. Unless you specify otherwise, we consider any incoming mail available for possible quotation -- but not with the sender's real name unless you explicitly state that it may be used. If you are wondering why Fallows does not use a "Comments" field below his posts, please see previous explanations here and here.
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