The Federal government has promised far more than it can deliver. They cannot fulfill these promises. Medicare and Medicaid were enacted in 1965, the last time a Democratic President decided to improve the lives of Americans by enacting Great Society programs that have saddled future generations with society crippling debts. The initial beneficiaries never paid a dime into the plan. When it was enacted there were 6 workers per beneficiary. By 2030 there will be 2.4 workers per beneficiary. The Congressional Budget Office estimates that to cover the future deficits through tax increases would require a doubling in tax rates, with a top marginal rate of 66%. The current cast of Congressional criminals won’t dare touch Medicare. They fear the wrath of the AARP and the liberal do-gooders who refuse to deal with reality. Their solution to every problem is – TAX THE RICH (the 53% of Americans who actually pay taxes).

The entire healthcare debate needs be put on hold until the looming Medicare disaster is solved. A combination of the following ideas must be enacted:

• Since Medicare is a fee for service model, millions are wasted on unnecessary tests. Researchers at Dartmouth Medical School estimate that 30% of Medicare spending does nothing to make beneficiaries healthier. This is a waste of $150 billion per year. The incentive to conduct unneeded tests must be taken away.
• Medicare’s lack of controls and administrative oversight results in annual fraud losses of $200 billion. The GAO found that questions from providers at Medicare Call Centers were answered correctly 4% of the time. A commission of experts from industry and the GAO needs the ability to make drastic changes in the system to eliminate this fraud.
• Allow the free market to work by giving new enrollees a means tested voucher that can be used to purchase the health plan of their choice.
• Allow seniors to opt out of Medicare, without losing their Social Security benefits.
• Allow new workers to save their 2.9% Medicare tax in an inheritable account dedicated to retirement healthcare costs

The 1,990 page bill being forced through Congress in no way deals with the staggering waste of the current system, estimated to be $700 billion to $1 trillion annually. The waste flows from a culture of health care in which every incentive is to do more unnecessary tests. Doctors make more money and protect themselves from lawsuits. Congress has no intention of addressing this major cost driver, because the Trial Lawyers of America contribute millions of dollars per year to lobby (buy off) Congressmen. Amazingly, 96% of their contributions (bribes) go to the Democratic Party. I wonder why medical malpractice lawsuits aren’t addressed in a 1,990 page bill written by Democrats. Total spending on medical malpractice, including legal-defense costs and claims payments, was $30.4 billion in 2007, according to an estimate from consulting firm Towers Perrin. At the University of Miami’s School of Medicine patient practice, 14 cents out of every dollar collected in fees for services to patients goes toward buying medical malpractice insurance. In a 2003 report that called for medical liability reform, the U.S. Department of Health and Human Services estimated that limits on malpractice awards could save between $70 billion and $126 billion a year. This is likely on the low end, as it is extremely difficult to gauge how many unneeded tests are ordered to avoid a lawsuit.

The Democratic congressional leadership has evaded solutions to the random, costly and time-consuming jury-by-jury malpractice system. Texas passed a law in 2003 that caps liability awards at $250,000 for noneconomic damages such as pain and suffering, a move that has led to fewer malpractice suits being filed. According to Texans for Lawsuit Reform, a lobbying group that supports the caps, medical-liability-insurance rates have declined an average of 21% in the state since the law change, with almost a quarter of doctors seeing a 50% decrease. Pilot projects could test whether this system should be replaced with expert health courts, but leaders who say they want to cut costs will not even consider them. Expert courts might succeed and undercut the special interest of the trial lawyers. An expeditious and reliable new system would compensate patients more quickly and at a fraction of the overhead of the current medical justice system, which spends nearly 60 cents of every dollar on lawyers' fees and administrative costs.

Expert health courts would eliminate the need for "defensive medicine," thereby helping to save billions in costs. Defensive medicine, the practice of ordering tests and procedures that aren't needed to protect a doctor from the remote possibility of a lawsuit, is ever-present. A 2005 survey in the Journal of the American Medical Association recounted that 93% of high-risk specialists in Pennsylvania admitted to the practice, and 83% of Massachusetts physicians did the same in a 2008 survey. The same Massachusetts survey showed that 25% of all imaging tests were ordered for defensive purposes, and 28% and 38%, respectively, of those surveyed admitted reducing the number of high-risk patients they saw and limiting the number of high-risk procedures or services they performed. Defensive medicine is notoriously hard to quantify, but some estimates place the annual cost at $100 billion to $200 billion or more. Quantification is difficult because defensiveness is now entrenched in the culture of American health care. It's hard to separate the financial incentives from the distrust of the American justice system. There are hundreds of billions in savings that could be achieved if Congress chose to focus on the right issues. Instead they will add a $1 trillion bureaucracy that will increase costs for all Americans while delivering poorer quality healthcare. 

The waste and fraud in the current healthcare system will not be alleviated by inserting a new government bureaucracy into the equation. A Thomson Reuters report disclosed these findings:

• Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37% of healthcare waste or $200 to $300 billion a year.
• Fraud makes up 22% of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
• Administrative inefficiency and redundant paperwork account for 18% of healthcare waste.
• Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11% of the total.
• Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.
• The average U.S. hospital spends one-quarter of its budget on billing and administration, nearly twice the average in Canada.

History of Government Failure

 “It is hard to imagine a more stupid or more dangerous way of making decisions than by putting those decisions in the hands of people who pay no price for being wrong.”

                                                                                    Thomas Sowell

There is one thing that is beyond doubt. When government gets their grubby little fingers on any aspect of society, it costs the taxpayer more money and the task gets done incompetently, or not at all. It has taken decades of dreadful judgments, mismanagement and corruption to get to this breaking point. We went from a logical market based pay-as-you-go healthcare system in the 1950s to an illogical, bureaucratic, wasteful, litigious system that is bankrupting the country. The sorrowful path through the years is painful.