On Medicare: replace the entire structure with Medical Savings Accounts, privately owned like IRAs. This would be optional at first, since people already receiving it, or close to that, would be left stranded if it suddenly disappeared; after all, they've been paying for it their entire careers.
Most medical expenses occur later in life. For everyone else, the accumulated value of their Medicare accounts, including credit for presumed interest during the life of the account, would be transferred to their private accounts. A one-time yuge expense for the government, but in the long run, tremendous savings from escaping the pyramid scheme, while returning independence to people to run their own lives. Most people can invest amounts equivalent to what we are now forced to pay into Medicare while we work, so net expenses would remain the same. The accounts grow by earning interest and only withdrawals are taxed, so we can save it up for the rainy days we all eventually face.
States then devise their own safety net programs for those who cannot fund such accounts sufficiently. Additionally, private insurance should be allowed to offer options like major emergency coverage only, and people should be educated that going to an emergency room for a sore throat is not an appropriate use of insurance. We don't begrudge our less fortunate citizens the care they need.
But running these programs at the state level has two major advantages: states cannot "print" money, so the citizens of that state have to vote for it; in doing so balance that need against others. And state governments are proportionally just as bloated as the federal, in part because the latter subsidizes those excesses. Not a State DOGE, but simply the power of the ballot box to make the tradeoffs as determined by those paying the bills.
Thanks, Frank, I’m a big fan of medical savings accounts (I still have one) but alone they’re not enough for Medicare. I have a lot of friends who are a lot more learned and experienced than me in this space, but I think you’re right that we should focus more on well-regulated private than public insurance. After 35 years, I still believe the Consumer Choice and Health Security Act from 1993 remains the approach (with modifications) for national health insurance reform. It had 25 US Senate cosponsors as a counter to “Hillary Care.” It didn’t touch Medicare, but that was the next step. More here: https://www.heritage.org/report/the-consumer-choice-health-security-act-s1743-hr-3698
Not many are qualified to write a piece like this credibly. Terrific work.
Hi praise from the master.
On Medicare: replace the entire structure with Medical Savings Accounts, privately owned like IRAs. This would be optional at first, since people already receiving it, or close to that, would be left stranded if it suddenly disappeared; after all, they've been paying for it their entire careers.
Most medical expenses occur later in life. For everyone else, the accumulated value of their Medicare accounts, including credit for presumed interest during the life of the account, would be transferred to their private accounts. A one-time yuge expense for the government, but in the long run, tremendous savings from escaping the pyramid scheme, while returning independence to people to run their own lives. Most people can invest amounts equivalent to what we are now forced to pay into Medicare while we work, so net expenses would remain the same. The accounts grow by earning interest and only withdrawals are taxed, so we can save it up for the rainy days we all eventually face.
States then devise their own safety net programs for those who cannot fund such accounts sufficiently. Additionally, private insurance should be allowed to offer options like major emergency coverage only, and people should be educated that going to an emergency room for a sore throat is not an appropriate use of insurance. We don't begrudge our less fortunate citizens the care they need.
But running these programs at the state level has two major advantages: states cannot "print" money, so the citizens of that state have to vote for it; in doing so balance that need against others. And state governments are proportionally just as bloated as the federal, in part because the latter subsidizes those excesses. Not a State DOGE, but simply the power of the ballot box to make the tradeoffs as determined by those paying the bills.
Thanks, Frank, I’m a big fan of medical savings accounts (I still have one) but alone they’re not enough for Medicare. I have a lot of friends who are a lot more learned and experienced than me in this space, but I think you’re right that we should focus more on well-regulated private than public insurance. After 35 years, I still believe the Consumer Choice and Health Security Act from 1993 remains the approach (with modifications) for national health insurance reform. It had 25 US Senate cosponsors as a counter to “Hillary Care.” It didn’t touch Medicare, but that was the next step. More here: https://www.heritage.org/report/the-consumer-choice-health-security-act-s1743-hr-3698
Milton Friedman was so brilliant.