At the risk of becoming mired in the past, we are inclined to glance backward now and then to see where we’ve been and ask what the past says about where we’re going. So let’s examine July 30, 1965, the date President Lyndon Johnson signed Medicare into law.
As may or may not be widely known, the initial forecast of the cost of Medicare was way off. In 1967, so the story goes, the House Ways and Means Committee guessed that Medicare would aggregately cost roughly $12 billion a year by 1990, a figure that ran fairly close to $110 billion by 1990.
In the intervening years, Congress and others involved in the Medicare policy discussion have perspired heavily over the future of Medicare and Social Security, and the annual Trustee’s report is a great way to find out who listens in on the conversation because they’re the ones who are always wringing their hands.
Rick Foster, the chief actuary at the Centers for Medicare & Medicaid Services predicted in May of last year at an event at the American Enterprise Institute that the Part A trust fund would be gone by 2024, but more recent estimates say 2017 or 2019, depending on whom you ask. Granted the fund is somewhat sensitive to economic conditions, but does anyone really expect a rising economy to balloon it back up to a 2024 expiry?
Lest we become tongue-tied trying to say “Part A trust fund” three times quickly, let’s not forget Part B, the terrain stalked by physicians. Cuts to Medicare spending on Part B imaging have been the norm since the Deficit Reduction Act of 2005, but the consensus now seems to be that this turnip has been bled dry. Squeeze all you want from DME bidding and fraud, but the Part B doc fix (a.k.a., the SGR mess) is still tabulated at $300 billion or better over a decade. You want to find offsets you say? In this fiscal environment?
One possible fix nobody really wants to think about is the use of the word “cost” in the statute that gave rise to Medicare. As many know, the government lost badly in the lawsuit of Hays v. Leavitt, and Hays v. Sebelius didn’t go much better if I’m not mistaken. Would the Independent Payment Advisory Board recommend that Congress allow the Centers for Medicare & Medicaid Services to use cost as a factor in coverage decisions? It’s hard to say, but we do know one thing: That rail has more juice to it than most third rails available to Congress, so only IPAB could get away with even saying such a thing.
So what will become of Medicare in the decades to come if current estimates of its cost are similarly delusional to those bandied about in the early years of the program? I can only guess, but I do know this: If we don’t fix it soon, Generation X will fix it when it finally achieves a majority in Congress. If Medicare is still draining the economy when that day arrives, the fix is nearly certain to be swift and brutal.