Gary M. Galles – December 30, 2019
Ever since Senator Bernie Sanders made “Medicare for All” (M4A) the centerpiece of his campaign, it has attracted support, and others have joined the bandwagon. In a Kaiser Family Foundation poll earlier this year, 56 percent of respondents and 81 percent of Democrats backed “a national health plan, sometimes called Medicare for all,” which has been used to assert a mandate for M4A.
Medicare’s Unfunded Liability
Since exactly what M4A details (where the devil lurks) are less than crystal clear, and even the best-articulated versions are more like political talking points than complete plans, backed by questionable, if not provably incorrect assumptions, the goal is clearly to pass a bill that would be very hard to undo before most citizens have any clear idea of what is involved.
Consequently, it is important to remember what most stories hyping the popularity of M4A leave out: When people were informed it would entail a massive increase in costs and taxes, support cratered. Given that Sanders’ proposal could add $3.2 trillion in annual government spending (when America now spends $3.5 trillion annually on health care), that is easy to understand. However, there is also another multi-trillion-dollar reason why many who now support M4A might switch sides: Medicare’s massive unfunded liability.
As with other Social Security expansions, when Medicare was created in 1966, those in or near retirement paid little or no more in taxes but got substantial benefits throughout retirement. That imposed a large unfunded off-budget liability on later generations. And every expansion since (most recently, Medicare Part D’s prescription drug benefit, whose officially estimated unfunded liability at the time was $17 trillion) has created another free lunch for those older, expanding the huge tab facing later generations.
The same sort of conclusions were reached in an Urban Institute study of Medicare, which found that in 2012, average-earning males were “buying” $180,000 in Medicare benefits for $61,000, while similarly situated females, with smaller lifetime contributions and longer life expectancies, did even better.
Optimistic Assumptions
The result, as reported by Michael Tanner, was a 2015 forecast of almost $48 trillion of unfunded liabilities under implausibly optimistic assumptions. A return to higher medical cost inflation rates could make it $88 trillion. A continuance of lower birthrates than forecast would push it higher. So would including future commitments to recipients who have qualified for but not yet received all their benefits as of the end date of a study.
So why might recognizing that massive unfunded liability and its continued expansion move Americans into the “anti-M4A” camp?
Because of the wealth transfer to early enrollees, as well as from ensuing expansions, Medicare provided many with a great deal. But that deal was the result of dumping an enormous bill on future generations (bigger than the unfunded liabilities for Social Security plus the national debt).
With that bill starting to arrive, Medicare is not even close to sustainable in its present form, much less to be leveraged to cover the entire population (although one can understand the vote-buying potential in promising massive new M4A generational transfers).
Not only is a massive expansion of an already far-in-the-hole Medicare program a fool’s errand, but the massive unfunded liabilities it has built up also mean that the previous costs were far higher than what recipients paid and continue to be so (even underestimates of its unfunded liability growth add more than $1 trillion per year of hidden costs to Medicare).
As a result, Medicare was a far worse deal than M4A salesmen and women admit, and it is now decaying at an increasing rate, making its extension to all a 14-digit boondoggle, not a boon. And doubling (or more) down on the already unpayable burdens Medicare has laid on future generations also highlights the blatant hypocrisy of backers who, at the same time, preen about all the new plans they have to “invest in the future.”
Originally published at Fee.org. Gary M. Galles is a professor of economics at Pepperdine University.
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