John C. Goodman

The Democrats, however, will have none of this. Their idea of Social Security reform is raising the retirement age, reducing the rate of growth of benefits, raising the maximum wage subject to the payroll tax, etc. In other words, they want to tinker around the edges. And while they are perfectly willing to allow increasing the payroll tax on higher-income taxpayers immediately, all the spending reductions must only apply to future retirees, not current ones.

You see the problem? Tax increases get legislated now. Spending cuts take place at a time when some future Congress will have the opportunity to rescind them.

Reform of government health care programs follows much the same pattern for the Democrats. No fundamental reform. Only tinkering. Tax increases are immediate. Spending reductions get phased in in future years — but only if future representatives can withstand the political pressure.

One way to appreciate how the Democrats approach entitlement reform is to consider the way they chose to fund the Affordable Care Act (ObamaCare). Over the next 10 years, a new health insurance entitlement for young people is to be paid for by reducing Medicare spending by $716 billion. There is also a hefty increase in the Medicare payroll tax for higher income taxpayers.

However, the new Medicare payroll tax kicks in 2013, while the spending reductions phase in slowly, over time. Further, in their campaign rhetoric, the Democrats claim that seniors won’t even be harmed at all, since the spending reductions will come at the expense of doctors, hospitals and insurance companies.

Of course, when the doctors stop seeing senior patients (or start converting to concierge care), when the hospitals leave the market (as one in seven will in the next eight years, according to the Medicare Actuary) and when the insurance plans cut back on the benefits they are providing, there will be enormous pressure on Congress to reverse all of this. And most inside-the-Beltway folks are firmly convinced they will be reversed.

What would structural change look like? NCPA Senior Fellow Andrew Rettenmaier and NCPA Senior Fellow and former Medicare Trustee Thomas R. Saving explain how to reform Social Security with a system of private savings accounts — requiring a contribution equal to 5% of payroll during the working years. Rettenmaier and Saving propose a similar approach to Medicare reform that requires contribution of 4% of payroll to a health retirement account. I expand on Medicare reform in this study.

John C. Goodman

John C. Goodman is President of the Goodman Institute and Senior Fellow at The Independent Institute. His books include the widely acclaimed A Better Choice: Healthcare Solutions for America and the award-winning Priceless: Curing the Healthcare Crisis. The Wall Street Journal and National Journal, among other media, have called him the "Father of Health Savings Accounts.”