earn, regardless how poor they are, in order to subsidize medical bills for
those over age 65, regardless how rich they are. There is no conceivable
justification for such a scheme. Yet both Republicans and Democrats are now
threatening to "reform" Medicare by greatly increasing future subsidies, and
thus increasing future Medicare taxes.
The problem with the plan offered by House Democrats is that its
10-year cost is about $1 trillion, which is $1 trillion too much. The
problem with the Bush administration's plan is that its 10-year cost is $400
billion, which is $400 billion too much. Taxpayers are already burdened with
more than 45 percent of all medical bills. That is not because 45 percent of
all Americans are poor. On the contrary, those being subsidized are often
more affluent than the taxpayers who subsidize them.
Additional subsidies for prescription drugs would boost demand
for such drugs and drive up their prices, thus pushing actual spending much
higher. Even without these drug subsidies, the annual cost of Medicare is
projected to soar from $224 billion in 2000 to $425 billion by 2011. Costs
will rise even faster after 2011, as the percentage of the population over
65 really begins to soar. Medicare is insolvent, and extra subsidies could
make its coming collapse really ugly.
As expensive as Medicare is, it covers only half of all medical
expenses of the elderly. No sensible person would participate in Medicare if
it were not both heavily subsidized and mandatory. Medicare not only fails
to cover prescription drugs, it also fails to cover even routine physical
exams, eye tests, hearings aids and, most importantly, catastrophic
expenses. Seniors are compelled to buy private medigap insurance to fill
some of these gaps, but medigap options for drug insurance are severely
limited by law.
Although there is much more to the president's plan than
prescription drug insurance, that is the key issue on which political
battles are being fought. Better access to drug insurance is one thing; fat
subsidies are quite another. Sen. Olympia Snow, R-Maine, has been widely
quoted saying, "Every senior should have access to comprehensive drug
coverage, regardless of which Medicare option they choose." Better access is
indeed unobjectionable. The administration's fact sheet, by contrast,
asserts that "all seniors should have the option of a subsidized
Why should turning 65 entitle anyone to subsidies?
The main reason seniors have limited access to prescription drug
insurance is that in 1992 Congress made it a crime for any insurance company
to offer such insurance.
More precisely, Congress required that Medigap policies be
offered as only 10 package deals, with health insurance available only
within the three most expensive packages. Although a Congressional Budget
Office study says "medigap policies ... charge high premiums for drug
coverage," that is not really true. Medigap policies appear to charge high
premiums only because drug coverage is wrapped up in a big bundle with
various other benefits, including coverage for foreign travel and for the
entire cost of Medicare deductibles. You have to pay for costly insurance
you don't want in order to get the drug benefit. The obvious solution is to
unbundled the prescription drug plans, allowing drug policies to be sold
separately and allowing insurance companies to offer more or less generous
drug benefits for higher and lower prices.
Drug insurance within the top three medigap plans is far more
costly than a separate catastrophic policy with a large deductible, but
Congress made it illegal to offer such an inexpensive policy. The standard
plans, by contrast, leave seniors dangerously exposed to unusually high drug
costs. The annual deductible in the standardized plans is too low ($250),
co-payments are high (50 percent), and drug expenses that exceed $6,250 are
not covered by even the most expensive plan. "Only 17 percent of Medicare
beneficiaries will spend more than $5,000 on prescription drugs in 2005,"
CBO estimates, "but their combines spending will make up nearly 54 percent
of total drug expenditures by Medicare beneficiaries that year."
People are generally quite satisfied with the quality, choices
and prices of goods and services they buy in the competitive marketplace. If
you don't like one supermarket or restaurant, you try another. Once the
government gets involved in either providing services directly (schools and
postal service) or mandating how private services must be provided (the
standardized medigap policies), the resulting loss of choice and competition
invariably leaves many people unsatisfied.
The appropriate solution would be to minimize government
involvement in such matters, such as leaving medical insurance questions to
the insurance companies and their customers. But the idea of solving
government blunders by undoing them rarely gets much political attention.
Instead, politicians invariably offer to fix problems caused by one
overpriced, overbearing government program by adding yet another overpriced,
overbearing government program. So it is today with these competing plans to
fix the simple problem of federally limited access to drug insurance by
granting huge subsidies to old folks, regardless of their income or wealth.
Fixing the access problem would be extremely easy, and the cost to taxpayers
would be just what it should be -- zero.