“[Americans] are the richest people on the planet, but they have come to rely on the savings of the world’s poorest people just to pay their bills. They routinely spend more than they make—and think they can continue doing so indefinitely. They go deeper and deeper in debt, believing they will never have to settle up. They buy houses and then mortgage them out—room by room, until they have almost nothing left. They invade foreign countries in the belief that they are spreading freedom and democracy and depend on lending from Communist China to pay for it.
“The entire homeland economy now depends on the savings of poor people on the periphery to keep it from falling apart. Americans consume more than they earn. The difference is made up by the kindness of strangers—thrifty Asians whose savings glut is recycled into granite countertops and flat-screen TVs all over the United States.
“Americans believe they can get rich by spending someone else’s money. They believe that foreign countries actually want to be invaded and taken over. They believe they can run up debt forever, and that their debt-laden houses are as good as money in the bank.
“The dollar is an extraordinary thing too. Do you know what the long term mean value of paper currency is? Well, it is zero. That is what they average paper currency is worth most of the time…and it is the black hole into which all paper currencies in the past have gone…For the last hundred years, the dollar has lost value faster than the decline of the roman-era Dinarius after the reign of Nero. This is not surprising. Roman coins had silver or gold in them. In order to make the coins less valuable, they had to reduce the precious metal content. People didn’t like it. The dollar, by contrast, contains no precious metal. Not even any base metal. It is just paper. It has no inherent value. There is nothing to take out, because there was never anything there in the first place. Over time, the dollar is almost certain to revert to its real value—which is as empty as deep space.” Bill Bonner and Addison Wiggin, Empire of Debt: The Rise of an Epic Financial Crisis, p. 3f
“The unfunded liability in Medicare, the trustees tell us, is $34 trillion over the next 75 years.
“The ‘alternative’ scenario for Medicare produced by the Congressional Budget Office in June 2012, the long-term shortfall is more than $100 trillion.
“Meanwhile, the fiscal gap separating the present value of all future projected federal expenditures…based on the CBO’s projections, a staggering $222 trillion.” John C. Goodman and Laurence J. Kotlikoff
White House spin pretends otherwise, but the unfunded liabilities may exceed $100 trillion.
John C. Goodman and Laurence J. Kotlikoff, The Wall Street Journal, June 25, 2013, p. A 13
Even before the latest Medicare trustees report came out at the end of May, the White House spin masters had already crafted a story to go with it. Medicare’s finances have improved, we’re being told. The trust fund will last longer. The unfunded liability is lower. One of the reasons is said to be ObamaCare.
The core of the new health reform doesn’t kick in until next year, but already it’s improving things for seniors? Here’s the real story:
In their report, the trustees acknowledge that current law envisages dramatic reductions in future Medicare outlays which may be “difficult to sustain.” The president’s new budget also paints a rosy picture of Medicare’s present and future finances.
Yet even with these unrealistic assumptions about Medicare costs, the future looks bleak. The unfunded liability in Medicare, the trustees tell us, is $34 trillion over the next 75 years.
Looking indefinitely into the future, the unfunded liability is $43 trillion—almost three times the size of today’s economy. Based on more plausible assumptions, such as those reflected in the “alternative” scenario for Medicare produced by the Congressional Budget Office in June 2012, the long-term shortfall is more than $100 trillion.
Take one source of optimism that the trustees are compelled to transmit in their latest report. Its predicted expenditures are based on the assumption built into the law that next Jan. 1 there will be a 25% decrease in the fees that Medicare pays doctors. That means that every doctor in America who participates in Medicare will take a 25% pay cut. The reason has nothing to do with ObamaCare. In the Balanced Budget Act of 1997, Congress declared that Medicare physician fees could grow no faster than the economy as a whole. Since then, though, Congress has postponed the cuts on 14 occasions, not allowing them to take place. Why assume things will be different now?
A second problem does stem from ObamaCare. In order to pay for the expansion of health insurance for the young, the new health law calls for steep cuts in the growth of health-care spending on the elderly. Whereas Medicare spending per person in real terms has been increasing at about the rate of growth of real GDP per person plus two percentage points, the ObamaCare law calls for a spending growth rate of GDP plus 0.04%. Assuming this slower growth rate will materialize, over the next decade it produces about $716 billion in savings.
How is this supposed to happen? There have been a number of demonstration projects that were supposed to find more efficient ways of delivering care. But three separate CBO reports have found that these programs—such as the use of electronic medical records and “coordinated care”—don’t work to cut costs.
As a result, Medicare will have to resort to a fallback mechanism: more cuts in provider fees. Were these cuts to be implemented, and if Medicare spending grew no faster than the economy as a whole, the problem of Medicare would be solved.
Yet studies by the Medicare actuaries in 2012 show that for this formula to work, the suppression of provider fees would have to be draconian. Medicare fees would fall below the reimbursement rates for Medicaid next year and fall further and further as the years go by. By 2030, for instance, doctors treating Medicare patients would be paid 40% of private health-insurance fees. The Medicare reimbursement to hospitals for inpatient treatment would fall to 60% of the private-insurance level.
From a financial point of view, senior patients will become less desirable than welfare recipients. Medicare’s Office of the Actuary is predicting that one in seven hospitals will completely leave the Medicare system by 2020 because of these pay cuts.
This is not a new problem. When the Affordable Care Act was passed in 2010, Medicare’s chief actuary, Rick Foster, said the cuts envisioned would damage access to care. Harvard health economist Joe Newhouse predicted that seniors may have to seek health care at the same places frequented by Medicaid patients today—at community health centers and the emergency rooms of safety-net hospitals.
So not much is looking up after all. If Congress caves to political pressure and continues to restore cuts in provider fees, as it has done since 1997, the unfunded liability in Medicare will be far greater than what the trustees are now showing.
Meanwhile, the fiscal gap separating the present value of all future projected federal expenditures—Social Security, Medicare, Medicaid, ObamaCare, defense, gassing up Air Force One, servicing existing debt, you name it—and all future federal taxes and other receipts is, based on the CBO’s projections, a staggering $222 trillion.
Mr. Goodman, president and CEO of the National Center for Policy Analysis, is the author of “Priceless: Curing the Healthcare Crisis” (Independent Institute, 2012). Mr. Kotlikoff is a professor of economics at Boston University and co-author of “The Clash of Generations” (The MIT Press, 2012).
A version of this article appeared June 25, 2013, on page A13 in the U.S. edition of The Wall Street Journal, with the headline: Medicare by the Scary Numbers.