I am a libertarian Republican. I do not support the elimination of Medicare with no replacement nor do I support reforms that are intended to dismantle Medicare with no replacement. I support reforms that would modernize Medicare and bring it into solvency, OR, possibly, the replacement of Medicare with mandatory Medical Savings Accounts (MSAs). I admit as a libertarian Republican the idea of MSAs intrigues me, but I have serious reservations. I support personal accounts for Social Security. This discussion should assume that those were signed into law, and that MSAs were signed into law. This is a discussion about how they would work, not the feasibility of them passing. First off, how exactly would MSAs work? My understanding is the taxes that the first owners of these mandatory MSAs would normally be paying into Medicare would simply be channeled into MSAs instead, and that the revenue Medicare loses from the transition would be made up with general government revenues, and the addition to the deficit this causes would be made up for with other spending cuts. What would happen next? Would the government invest the money in these accounts in safe growth options? Would the government give individuals a few safe investment options to choose from? Or would individuals simply have total control? Conservatives and libertarians out there which would be the best option? Now, a few of my reservations. The taxes that went into these MSAs would presumably be much lower than taxes that would go into personal retirement accounts (my own preference on reforming Social Security) so the amount of money in these accounts would be low for poorer people because they would be paying low taxes on a low income. Would poor people, even with good investments, have enough money to pay for insurance/medical expenses for the rest of their lives? My thought is that you might have to raise MSA taxes to be higher than Medicare taxes, but that would hurt poor people and the economy at large. If we had switched to personal accounts for Social Security, would it be practical to lower those taxes and raise MSA taxes? Honestly idk. Also, will most people have the money in these accounts to pay for health insurance for more than a few years? Forgive my ignorance on the subject, but aren't insurance premiums too high for individuals to pay right now, and isn't that why most people have insurance provided by their employers? Also, doesn't Medicare cover preexisting conditions, and wouldn't switching to MSAs cause these people to not get health insurance that would have previously been covered by Medicare? The main appeal that MSAs have to me is that they will never contribute to the deficit because the money is put into personal accounts and not spent by politicians. Overall (and I don't have an answer to this question) is it better to just raise the age of eligibility and make sone reforms to Medicare to ensure its solvency and stick with "devil we know"? Liberals feel free to chime in with your opinions but please no ad hominem attacks, and I'm really looking for the opinions of libertarians and conservatives.
Medical Savings Accounts aren't a substitute for Medicare, or any insurance; they are just an addition. Normally, they work in conjunction with high deductible insurance plans. So a plan with say, a $10,000 deductible would basically be there for emergencies, like serious diseases or major accidents. When it comes to routine care, that would be on a cash basis, or through the MSA. So I don't see a circumstance where MSA's could be any sort of substitute for a health plan.
The problem is the continuation of a corrupted medical billing system that rewards "procedures". A cardiologist threading a catheter to a coronary artery makes more money if he leaves a stent or three. The solution is not diagnosis fee based billing because some patients require extra care. SOLUTION: Physician reimbursement is time based regardless of what he is doing at the time. A cardiologist would make as much teaching you how to live with your heart disease as placing stents per minute. This would improve the quality of today's procedure based medical care. Until this problem is reformed, no degree of insurance will suffice. Moi BTW NO stent will keep you alive longer then a stent, per repeated studies. First 6 months after stent are high energy. Then all is same ole, same ole except you die sooner.
A recent study shows that men in particular, who use high deductible health care, tend to defer needed medical care. This causes much worse outcomes for them than if they had standard health insurance. http://journals.lww.com/lww-medical...of_High_deductible_Health_Plans_on_Men.2.aspx
