Earning my presidential vote: entitlements

Social Security was once considered the “third rail” of American politics: touch it and you die. But I would contend that we have added Medicare, Medicaid, and perhaps Obamacare to that description. Republicans talked tough about repealing Obamacare through defunding it, but chickened out when the threat of being blamed for a government shutdown became the price to pay. But knowing the toll these programs take on our budget and idea of limiting government, I only need one bullet point for this one.

  • The next president should set in motion the eventual sunsetting of Social Security, Medicare, Medicaid, and Obamacare. If states are dumb enough to try this stuff, that’s their problem. But “promote the general Welfare” did not mean cradle-to-grave dependence on the federal government for support.

To re-introduce the candidates, we begin with Darrell Castle of the Constitution Party, then it’s Jim Hedges of the Prohibition Party, Tom Hoefling of America’s Party, Gary Johnson of the Libertarian Party, and independent Evan McMullin. Johnson is on the Maryland ballot; the rest are write-ins but their votes will count. And if you want to start this series from the beginning (this is the ninth part) you can go here and I link to each succeeding part in turn. At stake is thirteen points, which is the second-highest individual total.

Castle: Would repeal Obamacare and replace it with a “free market solution.”

Poor would be best helped on a voluntary basis. No provision for it in Constitution – money is not ours to give. (“Iron Sharpens Iron” radio show)

Hedges: “A financial foundation must be provided to those who cannot work.” There must be affordable housing, basic medical care, and convenient public transportation for all.

“We advocate an actuarially sound federal Social Security System.” (party platform)

Health care should be a state-level concern, but will address “inefficiency” from insurance company overhead and profits. (party platform)

Hoefling: All of the “entitlements” you list are unconstitutional. James Madison, the father of the U.S. Constitution: “I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence, the money of their constituents.”

We have a moral obligation to care for our older folks, and any who cannot care for themselves. But it is immoral to usurp power, and to rob our children and grandchildren in order to keep the socialist Ponzi scheme going.

We survived and thrived for 300 years in this country without socialism, by acting as Christians. We’re going to have to learn to do that again, one way or another. Because, within the space of the next eight or nine years, we’re going to see our government go completely insolvent trying to pay for “entitlements” and interest on the debt. In fact, the Congressional Budget Office has said that by 2025 the ENTIRE budget will have to go to those two things, with nothing left over for anything else. That is bankruptcy, on a Biblical scale. (response to question on Facebook)

Johnson: Johnson has personally endorsed privatizing Social Security, too — an idea favored by some Republicans (but not Donald Trump). This arrangement would let Americans self-direct their Social Security retirement funds through personal investment accounts, allowing them to buy stocks, for instance.

Johnson also favors raising Social Security’s Full Retirement Age from the current maximum of 67 to either 70 or 72. “Look, it’s [the Social Security Trust Fund] insolvent in the future. It’s going to be insolvent. It has to be addressed,” he told The Washington Examiner in July. Whether Americans could afford to hold off claiming until 70 or 72 to receive full benefits, however, is a real question, considering the majority of beneficiaries today start taking their Social Security money at the earliest age they can, age 62.

And Johnson would like to see Social Security begin “means testing that’s very fair.” Translation: The amount people receive in Social Security retirement benefits would be based on their financial well-being at the time they apply. Today, your benefit is based purely on your previous earnings.

Johnson would repeal Obamacare “in a heartbeat” if given the opportunity, he has said. “If the GOP bill lowers costs and improves care, I’ll sign it,” Johnson proclaimed in a CNN Libertarian Town Hall in June. On Joe Rogan’s podcast in May, Johnson blamed Obamacare for his health insurance premiums quadrupling “and I have not seen a doctor in three years,” he added. “I wish I didn’t have to have health insurance to cover myself for ongoing medical need.”

He wouldn’t have to under his main health care proposal.

Johnson would like to get rid of health insurance as we know it. Instead, Americans would buy health insurance only for catastrophic events and illness.

He believes a free-market system would lead to more affordable health care with price transparency and open competition. This system, Johnson told Rogan, “would probably cost about one-fifth of what it currently costs. We would have Gallbladders ‘R’ Us. We’d have gallbladder surgery for thousands of dollars as opposed to tens of thousands of dollars. We’d have Stitches ‘R’ Us, we’d have X-Rays ‘R’ Us. We’d have the radiologists next to X-Rays ‘R’ Us to read those X-rays.”

As for Medicare, Johnson told 60 Minutes correspondent Steve Kroft, “We’re not looking to eliminate Medicare. We do believe in a safety net.” But, he said to The Washington Examiner, “Medicaid and Medicare both need to be devolved to the states.” Johnson has referred to those programs as “the worst runaway expenditure in the federal government today.”

When he was governor, Johnson has said, “I oversaw the reform of Medicaid in New Mexico. Changed it from a fee-for-service model to a managed care model. Improved on the delivery of health care in New Mexico and saved hundreds of millions of dollars.” Johnson has maintained that if the federal government had given New Mexico 43% less money for Medicaid and put him in charge of the delivery of health care to the poor there without “all the strings and mandates that went along with their Medicaid money,” he could have done it.

As president, Johnson has said, he’d balance the federal budget partly by letting states restrict eligibility for Medicaid. (excerpts from Forbes article by Richard Eisenberg)

McMullin: Obamacare has failed American families, driving up costs and reducing access to quality healthcare. With costs running into the trillions, Obamacare is also sinking America further into debt while imposing hundreds of billions of dollars of new taxes. By emphasizing competition and innovation instead of government controls, we can build a modern health care system that delivers accessible, affordable, and high-quality care. We can also protect vulnerable populations, including patients with preexisting conditions. Real healthcare reform means putting patients, families, and doctors first.

Obamacare has proven incapable of controlling the growth of healthcare costs, which take an increasing cut out of workers’ paychecks or even force them to give up insurance. Major insurers are pulling out of Obamacare exchanges because the program is so poorly designed and so full of complex regulations that the insurance companies are losing money despite vast federal subsidies. The cost of those subsidies will be $1.2 trillion over the next 10 years, or an average of $120 billion per year. The program will also impose more than $200 billion in penalties on workers and employers – and still 33 million Americans won’t have health insurance.

We must repeal Obamacare as soon as possible, replacing it with a more streamlined, pro-market approach to insurance. The few positive elements of Obamacare, such as guaranteed coverage for pre-existing conditions, could easily be incorporated into a new program in a much more efficient manner.

The heart of any Obamacare replacement should be a tax credit for every household that does not have insurance through an employer. Instead of the government defining a long list of benefits every insurance plan must have, customers should be able to tell insurance companies what they want. This will spur competition and ensure that the tax credit is sufficient to purchase any number of different plans. Allowing the purchase of insurance across state lines would also increase competition and bring down costs. Finally, encouraging the use of Health Savings Accounts (HSAs) will help create more educated consumers who seek treatment from efficient and high quality providers.

Medicare plays an indispensable role in providing health care for America’s senior citizens; it must be put on a sound financial footing so that all Americans have access to high-quality care in their retirement years. The only way to preserve Medicare for the next generation is to get hold of the runaway costs that threaten the program’s viability while spurring massive growth of the federal debt and deficit.

Established 50 years ago, Medicare hasn’t adapted to an aging population with a rising life expectancy. Instead of covering 1 in 10 Americans, the program now covers 1 in every 6—or 50 million men and women—who spend close to 20 years as Medicare patients, up from just 15. At the same time, relentless inflation in medical costs has led the cost of coverage to triple. Whereas payroll taxes and premiums once covered 70 percent of costs, the government now spends $700 billion per year while collecting only $100 billion from Medicare payroll taxes.

Without reform, Medicare and other entitlements will push our government to the edge of bankruptcy. Evan McMullin is not afraid to challenge the status quo in order to put Medicare on a sound footing for the future.

The way to reform Medicare is encourage competition and innovation by putting patients, families, and doctors for first. The key to reform is premium support, a system in which all beneficiaries would receive a uniform subsidy toward the purchase of coverage from competing health plans, including the option of traditional Medicare. This approach would give seniors greater freedom to choose the plan that best suits their needs, while spurring competition among plans to provide the best quality care at the most efficient price.

To promote informed decision-making by beneficiaries, the federal government must develop and distribute user-friendly publications that enable beneficiaries to compare plans, estimate out-of-pocket costs, and assess the quality of competing providers. By making informed decisions, beneficiaries can encourage a cycle of competition and innovation that leads to better outcomes for all.

Medicaid’s purpose is to provide lower-income Americans with the health care they need but can rarely afford. Despite its tremendous cost, there is little evidence that Medicaid is actually improving the overall health of the citizens it insures. The program should be reformed substantially, so that it continues to fulfill its critical mission without pushing our national debt past the breaking point.

When first established in 1966, Medicaid covered just 2 percent of the population. Today it covers more than 20 percent—almost 70 million men, women, and children. Obamacare alone has pushed 12 million individuals onto Medicaid. The annual cost of the program has risen to $550 billion, an increase of $200 billion under President Obama. The cost per beneficiary has also risen sharply to more than $7,000 per year.

Along with other entitlements, Medicaid is pushing our government to the edge of bankruptcy. Evan McMullin is prepared to demand accountability from Medicaid, in order to bring costs under control while delivering better health outcomes for Medicaid patients.

Despite having a different purpose than Medicare, Medicaid would also benefit from reforms that emphasize competition and innovation while putting patients, families, and doctors first. Currently, individual states rely on federal matching funds for Medicaid. This leads to inefficiency because the system rewards states for spending more instead of spending more wisely.

Instead, there should be a cap on federal support. This can be accomplished by giving states block grants instead of federal matching funds, or by giving states a fixed dollar amount for each individual enrolled in Medicaid. The advantage of the latter is that in the event of an unexpected increase in enrollment—because of a recession, for example—states will be able to handle the change.

This would be complemented by paring back the extensive restrictions that Washington places on state Medicaid programs, which discourage innovation and prevent states from taking full responsibility for outcomes. Medicaid could also become far more responsive to patient needs by creating a separate program for disabled and elderly recipients, whose needs are far different from able-bodied adults and their children.

Together, these changes provide a promising way to increase the accessibility of healthcare to Medicaid participants. Right now, many doctors refuse to accept Medicaid patients because reimbursements rates are so low. These reforms point the way toward ensuring that Medicaid patients become valued customers, not second-class citizens. (campaign website)

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If I could have gotten more depth out of Darrell Castle, I would have likely scored him higher. Philosophically he’s correct that we should be our brother’s keeper, but I would like to know how he gets from point A to point B. 5 points.

The statist tendencies of Prohibition candidate Jim Hedges come through in this answer. It is not the government’s job to provide the items he specifies, at least not according to my Constitution. No points.

Tom Hoefling has a great answer, and it’s the honest truth: the system as is will be unsustainable. More detail on how he would address the issue would be good, but he also has a correct philosophy. 10 points.

Gary Johnson wisely takes the first baby steps toward some of my goals: privatizing Social Security, devolving Medicare and Medicaid to the states, and repealing Obamacare. I would expect this from a Libertarian, although in the case of Social Security it’s tempered somewhat with changes in retirement age and the gimmick of means testing. It’s a good policy overview rather than a philosophical one. 9.5 points.

This topic is another example of a “tinker around the edges” philosophy of Evan McMullin. Instead of reforming the programs and slapping yet another Band-Aid on a gaping wound, the idea should be one of addressing the very function of a program that the government shouldn’t be involved with. He would unnecessarily consign yet another generation to the slavery of governmental dependence because eventually the reforms will need reforms of their own. 3 points.

I have just two more categories to go. Tonight I will discuss the role of government and tomorrow will be the intangibles and final decision.

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One Response to “Earning my presidential vote: entitlements”

  1. […] We are getting down to the final two categories as well as the intangibles. Next I tackle the ticking time bomb of entitlements. […]

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