Does Medicare have one foot in the grave already? The Trustees of the Medicare program recently announced that the program will remain solvent through 2026. After that, there won’t be any assets in the trust fund — and Medicare will be officially bankrupt. However, reports of Medicare’s coming death appear to be greatly exaggerated.
It’s complicated
For one thing, Medicare isn’t really just one program. Medicare Part B, which covers physician and other outpatient services, and Part D, which covers prescription drugs, are financed through a separate trust fund. This trust fund receives money from the general treasury of the U.S. and enrollee premiums, which are reset each year. These parts of Medicare won’t go bankrupt.
Medicare Part A, which covers hospital costs, does face insolvency. What this means is that the Medical Hospital Insurance Trust Fund will run out of money and no longer be able to pay for all the bills. However, enough money will still be coming in from taxes and other revenue sources that a large portion of those bills could still be paid even if nothing was done — around 87% initially and drifting down to 71% by 2050. This isn’t a good situation by any means, but seniors don’t need to be worried that Medicare will cease to exist.
Don’t trust the trustees?
Some might think things are actually turning the corner for Medicare. The insolvency date for Medicare was previously projected for 2024. The latest Trustee report, however, extended that date out two years through 2026. Don’t put too much confidence in these revised projections, though.
The Trustees basically say to not trust their numbers in the recent report. Their projections assume that payment rates for physicians will be reduced by 25% beginning in 2014. However, the White House and Congress have overrode these physician cuts every year since 2003. As the Trustees say in their report, it’s a “virtual certainty” that they will continue to do so.
A rosier outlook for Medicare in the latest Trustee report stems in part from lower-than-expected skilled nursing spending in 2012. The projections also count on an improved economic outlook over the next several years. The report correctly states that the primary cost driver for skilled nursing is labor. The weak economy has probably held those labor costs down. I suspect that if the economy improves considerably, skilled nursing costs will return to higher levels. If the economy doesn’t improve, the projections will be off. Either way, the more positive outlook could be undermined.
Grim outlook
Medicare isn’t in danger of dying anytime soon, but that doesn’t diminish the magnitude of the overall danger. The program has spent more than it took in each year since 2008 and faces even more serious problems ahead.
As a result, Medicare will consume an increasing share of the overall U.S. gross domestic product. This trend will crowd out available federal funds for other programs. Even worse, Medicare deficits will grow and require more additional federal spending to supplement the taxes paid by active workers and premiums paid by beneficiaries.
Surviving
What will it take for Medicare to survive well into the future? Some say that higher taxes are unavoidable. Of course, with fewer workers per beneficiary, that option could put a heavy burden on taxpayers. Others say the solution should come largely from trimming back benefits. But how to do this presents a challenge, to put it mildly.
Perhaps Americans’ best hope lies in one of the characteristics that make the country great — ingenuity. The Medicare Trustees themselves stated that scientific advances could “make possible new interventions, procedures, and therapies” with the result that “some conditions that are untreatable today will be handled routinely in the future.”
