Medicare: How much trouble is it in?

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By Janice Revell, Money Magazine senior writer

Three decades after Social Security was established, the federal government created Medicare to fund health care for the elderly. Today the government spends $10,000 every year, on average, on each person enrolled. And with healthcare costs growing at 2.5 percentage points faster than the economy, that number will keep climbing.

The conservative National Center for Policy Analysis notes that by 2050 more than 75% of federal income tax revenue will be soaked up by Social Security and Medicare if benefits and today's tax rates remain in place. It's Medicare that really drives that giant shift.

The Medicare system is several programs. Medicare Part A, which covers hospital care, is funded by payroll taxes and has a trust fund similar to Social Security's. But this is expected to run out much earlier, in 2019. To fix that, the system would have to double its payroll tax today, cut benefits by 50% or some combination of the two.

Part B, which covers doctor visits, and the new Part D, which pays for drugs, are funded by retiree premiums and the government's general revenue. They can't technically go insolvent, but as their costs grow, they'll have to raise their premiums even as they place a mounting burden on taxpayers as a whole.

The price you'll pay

First things first: Even if nothing else changes, your out-of-pocket medical costs are going to be higher than those of today's retirees. Not only will those Medicare premiums go up, but the many costs Medicare doesn't cover will rise as well.

According to the Employee Benefit Research Institute, a new retiree in 2016 will need to have saved more than $200,000 to cover retirement medical costs, assuming he or she lives to 90 and uses an average amount of prescription drugs. And that's assuming Medicare benefits aren't cut - not a safe assumption.

"There are going to be some major benefit cuts to Medicare in the next 10 years," says EBRI analyst Paul Fronstin. "You can't incrementally work your way out of the insolvency issue."

Benefit cuts could take a lot of forms. Modern health-care delivery is so inefficient that it's theoretically possible to cut out a lot of costs while delivering the same - maybe better - care. But it's just as likely that the Medicare system will do what private insurers have: thrust even more out-of-pocket costs onto you.

On the tax side, meanwhile, Medicare is going to be reaching into a lot of pockets in the coming decades. Since outpatient and drug coverage are financed from general government revenue, simply raising the payroll tax wouldn't fix the problem.

Income taxes could rise. Or capital gains and dividend taxes. Or the estate tax. Any way you slice it, the low rates of the Bush years aren't long for this earth, no matter who wins the November election.

Finally, there's "means testing" - that is, taxing affluent retirees. This has already begun in a small way. Part of the tax on Social Security benefits goes to Medicare. And starting in 2007, high-income retirees have had to pay bigger Part B premiums.

Once the system is fully phased in, retirees earning about $84,000 (or $168,000 as a married couple) will pay an extra $470 a year in premiums. The richest would pay $2,500 more. (The thresholds are adjusted for inflation.)

In the scheme of things, these aren't big bucks - yet. According to the Congressional Budget Office, only about 4% of Medicare beneficiaries pay the higher rate. Still, critics of means testing say the current income threshold is just the beginning.

"To raise any significant amount of money for Medicare, that will have to come down to the $40,000 range," says Maria Freese of the National Committee to Preserve Social Security and Medicare, a liberal advocacy group.

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