Four degrees of seperation – why Obamacare will fail…
Last October, I wrote the following post: “My suggestion to let the Democratic leadership pass a health care bill is based on the fact that we are talking about a Congress who will pass a flawed bill to save face before the 2010 midterm elections. The question, of course, is timing. If the Democratic leadership pass a bill in March of 2010, the failed outcome of their flawed legislation will not be felt by the American people until after the November election.”
The post was written as a prediction on how the Republican party can win seats in the mid-term elections based on the fate of the health care bill. Now, it seems like there is a bigger hurdle for Obamacare, the re-election diagnosis of the members of his own political party. Simply put, if Obamacare fails, it will be because of the survival mechanisms of first term Democratic members of Congress.
In the Democratic caucus, there are four groups of members who face different percentages of surviving their November procedures. An example of the definite survival group is Elijah Cummings (D-7, MD) who can vote for Obamacare fifteen different ways because of his mostly urban, mostly African-American constituency. The example of the highly probable group is Dutch Ruppersberger (D-2, MD) who would have to vote for the plan, get caught in a scandal, be videotaped kicking a cute animal and vote for every possible tax increase for Republicans to get over 35% against him.
Obama’s problem is the last two groups that in other years are safe Democratic seats or members who just won their first term in 2008.
In group three, the coin toss group, the example is Jason Altmire (D-4, PA). Jason has been in office since 2007 in a pretty safe conservative Democratic district. Jason has to walk a fine line between supporting the President and being true to his western PA roots. Hint: look at how Ron Klink (D-4, PA) survived the Clinton health care initiative in the mid-1990s.
The most vulnerable group, the folks who are on borrowed time, is exemplified by Frank Kratovil (D-1, MD). He is a first-term representative who won an open seat due to Republican inter-party stupidity. He is already facing a rematch with MD State Senator Andy Harris. Kratovil’s problem is not Harris – Obamacare will pass, in some form, the only cost will be the short political careers of people like Kratovil and other first term Democratic Congressmen.
35 Responses to “Four degrees of seperation – why Obamacare will fail…”
Let's just hope that the Democratic Senators and Representatives do the unthinkable for a change: that they vote for what they believe is right rather than for what they believe will get them re-elected…
The Dems have put themselves fully in this position; they are descending to the lowest of depths to pass poor legislation, which most Americans don't want; and if they force this through, what does that mean about what else they'll threaten to force on us? It doesn't look good.
Meanwhile, they are letting Medicare become worse, like Medicaid is, and could make it worse still.
http://www.nytimes.com/2010/03/16/health/policy…
Not only do these Dems show they can't be trusted this past year, can we expect them to correct this?
(Cost control and ** reduction ** of these over-extended “promises” [sic] needs to happen eventually.)
http://online.barrons.com/article/SB12684381587…
It's not entirely clear to me that voting their consciences (what they believe to be right) would result in a different outcome.
Look at it this way. If your primary concern is the expansion of coverage, you'd vote for the bill on the merits in a heartbeat.
If you're worried about the budget, you'd vote against it. It weakens the financial picture for Medicare by taking the easiest savings out and increasing Medicare taxes and using neither to shore up Medicare. Think about it this way. Medicare needs to increase revenues or decrease outlays from its baseline of 8 percent year on year increases to stay afloat. What does this bill do?
First is raise Medicare taxes. Second, it guts Medicare Advantage (except in FL of course). Third, it projects future cost increases in Medicare of 6 percent instead of 8 percent and it uses all of that money to “pay for” the new subsidies. If you look at it from the perspective of Medicare finances, you can now only help Medicare if you raise more Medicare taxes or cut the rate of growth in Medicare below 6 percent from its current trajectory of 8 percent. It's shocking to me that people do not understand how fiscally irresponsible this is.
Let's say that most people are worried about both to different degrees. The vote on conscience is just a vote to say I favor extension of coverage at the expense of our fiscal stability as a nation in general and Medicare in particular. Maybe 80 percent plus of Dems feel that way but I'm not so sure.
You need to realize that what the House leadership is doing right now is anything but appealing to conscience. They are using a combination of threats (e.g., we'll primary you, we'll oppose anything that goes to your district) and inducements (we'll give you X or make sure you get a nice job if you aren't reelected) to try to change the votes.
Perhaps you mean to say you hope they vote for what you believe to be right. How do we know what they believe to be right?
Further on this. Do you think Kucinich, who just announced he's voting yes is doing what he thinks is right from a policy perspective or from a party perspective. The guy has been on record for months saying he thinks the bill is bad but now he's voting for it. If there's nothing in the background, his logic probably has less to do with the merits on policy and more to do with party loyalty.
If that's doing what you think it right, so be it but then so if doing what you think will get you reelected.
I believe Kucinich is holding his nose and voting for the bill rather than for his interests (“single-payer”). This is the same challenge facing the Dems with Stupak and others who oppose the bill because of abortion.
Good points, steveinch.
My (naive, of course) opinion is that for millions of Americans there is not much time left to improve–in some cases get for the first time–health care. I look at health care as an urgent short-term problem that must be fixed. Yes, it may cost the taxpayers more (some of us are willing to bear that cost), and yest it will affect the budget. However, I believe that our budget/deficits are a long-term problem (important, nevertheless) which our country will be able to satisfactorily tackle, as we have tackled even bigger problems.
As to Kucinich, keep in mind that he has been wavering because the proposed health care reform bill doesn't go far enough for him. Good for him if he changes his mind…a bird in the hand is better than…..
I don't know whether him voting yes will enhance his standing with his voters or not
Many people are satisfied with their health insurance now (a silent group, normally), or they are either satisfied or unsatisfied, but they fear (with precedent established all this past year) that the Dems will make their situation worse, rather than better. They had the chance to do (only) real reform, and didn't.
That there are problems is not disputable.
“America's middle-class became uninsured at a pace faster than those with less or more income.”
http://www.rwjf.org/healthreform/product.jsp?id…
A quarter of Californians lack health insurance; from 6.4M in 2007 to 8.2M in 2009
http://articles.latimes.com/2010/mar/16/busines…
“I believe that our budget/deficits are a long-term problem (important, nevertheless) which our country will be able to satisfactorily tackle, as we have tackled even bigger problems”
How? Insight.
http://i.bnet.com/blogs/kaufmann-economist-blog…
Yes, we know, just as those lying, evil, juvenile, damn DemLibs lefties have made made the situation worse for millions upon millions of Americans with Social Security and Medicare…
And, yes I know, look at the dire straits those two programs are in now…so let's scuttle them. That will improve our deficits in one quick stroke
For one, let's not have any more “elective,” wars. (There one will find a couple of trillions)
Second, is it absolutely necessary to–at this time—have more of our men walk on the moon? (There are some more hundreds of billions)
Third, perhaps our billionaires–bless their hearts—can help out a little more (Untold billions there) ,
And the list goes on…
DdW,
Of the three you propose, only 1 is real money in the context of a trillion dollar budget deficit. The voluntary wars are about $100 billion per year. The entire NASA budget is about 25 and not all of that is for manned mission to the moon or Mars. And nobody makes a billion dollars a year so, until we have a wealth tax, that's gonna get you zero.
We don't need to scuttle them but do we need to make a bad situation worse by taking away the easiest and best steps to improver their finances?
Thanks for pointing out problems with my suggestions, steveninch. They were given on the fly… Albeit, I know we have plenty of billionaires and even more millionaires who could “help out a little more”, perhaps alltogether to the tune of hundreds of billions of dollars?
Can you think of some $$ saving suggestions?
Howdy, Dorian,
“let's not have any more 'elective,' wars”
We can do more with Defense, such as, ahem, procurement reform. (That brings to mind a story from my past — see end of this posting.)
I'm not about to join Barney Frank and insist on a prompt 25% reduction in Defense (to be misspent elsewhere — though some of it redirected to reformed entitlements might be win support), but I'm not surprised that the poll results I found about upcoming needs for reforms included cuts in Defense.
http://i.bnet.com/blogs/kaufmann-economist-blog…
Military retirement needs to be included in government retirement reform, eventually, too.
“[I]s it absolutely necessary to–at this time—have more of our men walk on the moon?”
No. I like manned-space achievements, but unmanned is much better bang for the (limited) buck; just ask all the frustrated scientists. And we don't “need” all desireable unmanned missions, either.
Note that we need to make cuts (and perhaps, an IMF-style auterity plan sometime later). It's only going to be tougher after 2020. It's an Era of Limits, the Limits to Growth — of Government.
“perhaps our billionaires–bless their hearts—can help out a little more”
Progressive taxation is not “fair” and often is envy-based, but I wouldn't be surprised if we saw more progressive (and increased) income taxes, and a wealth tax, eventually, too. Raising taxes right now is counter-productive given our stimulus (taxes need holding or reducing while spending needs to be increased, theoretically.) Raising taxes is not the best way to reform our finances in the long run; what are needed are cost controls and spending reductions. We need to get our deficits down and ideally change to surpluses (using tax increases when possible to rake off what can be snagged during booms) so that if we have another deficit (and we'll face entitlement problems in earnest after 2020, etc.) we won't balloon the debt to where it is a problem (as the EU nations are fearing currently) and we won't crush any economic revival or trigger a downturn or hamper the economy later from excessive taxes.
I have already been on record as saying one quick reform for entitlements is just to implement the tax increases the Trustees have said would make Social Security and Medicare solvent for at least 75 years. I believe it involves a payroll tax increase from around 14-15 per cent now to 20-21 per cent. Combine this with removal of the FICA tax cap (with or without adjusting benefits for those affected).
* * *
My own story about Defense: after a procurement scandal in the late 1990s I told some people, who wer conservative (our team meetings began with Clinton jokes) that liberal as it sounded, it might be better just to have the military design and produce all its weapons on its own, eliminating the private contractor, often privateering, middleman. (This is the same argument advanced now for Medicare for All.) I got quite an earful from the guys about that, though I tried explaining my position. (I got in similar trouble from one guy when I said that Clinton was behaving so badly at the time, I sometimes would be happy and relieved to see Carter put back in the White House instead.)
Noted and filed…
I've posted it before but if I were emperor.
1. Allow Bush and Obama tax cuts to expire.
2. Cut $100 billion from military spending
3. End all tax breaks to specific industries (oil, gas, wind, solar, etc)
4. Stop transfer payments to any individual or corporation with a net worth of more than 500k
5. Freeze in nominal terms all other spending in aggregate (not line by line).
My back of the envelope analysis says we could balance the budget in 5 years.
I should add (in case you haven't encountered it elsewhere) that to me the long-term future of health care in this country is going to be either Medicare for All or a change to VA for All to control costs even more strongly. By 2020 Medicare for All, even rapidly (within ninety days of enactment of legislation to do this) may no longer be an extremist position in this country. (Less extreme than the unsurprising view that if the UN ever gets really bad, we could leave it and expel it from the USA.)
DLS
“I should add (in case you haven't encountered it elsewhere) that to me the long-term future of health care in this country is going to be either Medicare for All or a change to VA for All to control costs even more strongly. By 2020 Medicare for All, even rapidly (within ninety days of enactment of legislation to do this) may no longer be an extremist position in this country. (Less extreme than the unsurprising view that if the UN ever gets really bad, we could leave it and expel it from the USA.)”
Once again, I am surprised to find we hold the exact same view of the future of health care. I just don't remember you saying anything about “single payer” in all the discussions. I no doubt missed that, as I would have seconded your position with pleasure.
The current bill is just the latest effort to put a fig leaf on the monopolistic take over of the health care discussion by the health industry. It's the primary reason single payer was never discussed in negotiations or in MSM.
I've even conjectured that the failure of this bill may ultimately be the best thing to happen if only to show just how costly health care can become if left to Insurance companies and their paid for congress.
How do you perceive the path to single payer?
I think its pretty clear how Kucinich had his “come to Jesus” moment:
In other words, his vote was bought plain and simple. What's funny about him is that the FDL folks were having a fundraiser on his behalf because he pledged not to vote for a bill unless it had the public option. Of the 65 members who signed that pledge, he was the last holdout. All that money raised (nearly $500,000) and every single one of them broke away from their pledge. I doubt the public option will get resurrected so maybe he's just grandstanding.
Howdy, Hemm –
“I just don't remember you saying anything about “single payer” in all the discussions.”
I've said that currently, this year, attempting single-payer rapidly (promptly) is too extreme, which is why the Dem leaders rejected it and sought some incrementalist stuff instead. (It looks like they didn't really know what they wanted, or don't know what they are doing. Not even having determined how to pay for it before starting it was enough by itself to spook us in the mainstream.)
“the failure of this bill may ultimately be the best thing to happen “
It's not going to set reform back a generation. Not even ten years. What's happening out there cannot be denied — it's getting worse all the time. There's a large silent group that's okay for now with their setup (in many cases I suspect they're worried) and others who don't like theirs, but fear being made worse rather than better off. The history of the Dems this past year only makes them (us) and everyone else even more nervous and less confident of a current resolution that makes sense.
“How do you perceive the path to single payer?”
I see the strategy as incrementalist. (Can't do too much at once, especially not now.) The key to any incrementalism strategy is to identify the increments (or steps or stages or whatever word you want that means what's being sought). The classic way is the age-pincer attack: the elderly and children (the dependents that are univeral across the population, not only the poor). Another is to help the poor. The idea is to help those who really need it — for this is a welfare program that's being expanded, even when it's universal, for all — so that the regular taxpayers (many of whom may be the most resistant to inclusion) are eventually able to be convinced that since they pay, they deserve to benefit more than anyone else — and many will then choose or even clamor to be included. “Mission Accomplished.”
Specifically we can try folding Medicaid and children's health into Medicare as one choice, possibly using stimulus money to pay the up-front costs and initial higher medical provider expenses of Medicare, as a stimulus measure and a way to federalize these and relieve the states of a burden they're glad to be rid of.
Next (in a list of choices, not list of priority) we can consider expanding coverage to children, all children (under-5, under-15, “children” under-18, under-21, under-25) which might appeal to many and which, as it reaches people of working age, puts them in the pool of taxpayers as employees at the same time (say age 16 or older, who are typically working).
Next comes extension down from current age 65 (the obsolete arbitrary retirement age) to something lower. This has to be carefully approached so as not to threaten liberal reversal of reality, wanting people to retire early or earlier instead of the later retirement that is the modern trend and the modern necessity. The way to do this is to ignore “retirement age” and address the insurance problems of older people, going down into the fifties or even, if merited, into the forties as a qualifying age — wherever an intelligent (and overdue!) study reveals the breakpoint where “older” people begin to have insurance problems more than those younger than them (the threshold of significance for this). Note that including younger people at the same time helps reduce the per capita costs. Extending Medicare to older people — the key is, what is “older” with respect to health problems and problems getting or keeping or affording insurance now?
Then there is the other area to attack, the insurance groups that have problems now — the individual insurance market participants, and the state high-risk pools. (The latter is another case where the states might be happy to be relived of this, and some stimulus money could be used with the aim of aiding the states in this way.)
An intelligent Medicare buy-in can be part of some of these expansions (rather than decision to offer to everyone in the named groups).
Separate from this might be reforms and changes. For example, Conyers wants all Medicare charges paid for with “mandatory” spending out of general revenues. Presumably no 80% of allowed charges any more (a 20% co-payment) and no “premiums” any more. That's actually a cleaner and better arrangement than we have now. We may as well get taxes set up right before extending coverage to others, and so on.
Thanks, Steveninch.
I agree with all of them except a blanket Defense spending cut of $100 billion, which is about 15 percent of the budget. I would want to see where the cuts would be, and I point out that $130 billion of the 2010 budget is for Iraq-Afghanistan war expenditures.
We could have saved much more than that every year if we had not elected to invade Iraq…but that's crying over spilled milk.
Thanks
“a fig leaf on the monopolistic take over of the health care discussion by the health industry”
Actually, I see it the other way, as I've written about elsewhere today. It's more lefty-style friendly fascism. This country doesn't normally have government (most of all the federal government) replace the private sector. Keeping private stuff private is the way it's done. The fascist “managed cartel” involving the biggest (private) parties in an often-consolidated industry or area of interest has been the model since the start of the New Deal (and has precedents in wartime earlier). This health care effort is just a kinder, gentler, and flakier(!) variant of the equally-fascistic HMO-”alliance”-based Clinton health care effort.
The insurers' days are numbered; they're in it as best as they can be as long as they still can be.
The problem with our health care system is the “insurance” model for pre-paid comprehensive care that everyone is expected to be able to get as and when they need it. I believe this model is doomed. The other related problem is that this is an employee benefit, often. (Not for many of us in the individual market or in the high-risk pools, or in Medicare or Medicaid or VA or Indian Health.) I believe that will go away eventually — if only as employers can't afford to continue providing it as a benefit and more of them stop. The single-payer model or full-socialist model (VA for All) eliminates both these problems.
I see VA for All as an alternative not only for cost controls but in addressing the more expensive infrastructure concerns we may have (imaging centers, hospitals, clinics, etc.) and the view many may have of these things specifically as future “public utility” items.
I neglected discussing VA otherwise and Indian Health but I can see folding Indian Health and even VA into Medicare (or Medicare into VA and renaming it) as related decisions to make eventually.
I agree with you on defense. I'm not sure that number is achievable in the short-term but in the 5 year time frame, it probably should be.
Iraq is one of those things where I am forced to say I simply don't know what the right answer was at the time. Judging in hindsight is always easier but I'll leave it at that since it's an entirely different issue and spilled (or spilt) milk.
And actually, I'm trying to write a book that both explains the fiscal situation, debunks some myths, and points to the solution described above. We'll see how that goes but I'm plowing through it 5 or so pages a day as we speak.
Look forward to your book
Dorian
: )
Well, I'll send you a signed copy assuming that (a) I finish it and (b) it gets published somewhere.
I'm sure I'll have plenty of extra copies.
It turns out that no public option will be introduced after all, considering that Kucinich will be returning a bunch of political contributions:
Aside from the way many of these types of deals have come to be and how they have been received by the public, I don't think enough attention is being paid to the serious interparty meltdown the Dems appear to be having. If one reads that entire piece over at FDL, you'll be treated to one heck of a timeline on how this whole thing went down. While I understand that FDL is considered to be a liberal blog, some in the center should consider this:
Now I can certainly raise a green glass to that. Cheers everyone!
DLS
“I see the strategy as incrementalist. “
The problem with this strategy is seen in the current situation. As long as big insurance lobby money drives any bill, even a small step like the public option is dead.
The steps you outline make as much sense as any, but step 1 would seem impossible as long as congress needs money to stay in office. My thoughts on lobbying have been stated here many times, and this is just another example where money for votes guarantees the US nothing but the economically disastrous status quo.
Health care and Social Security go hand in hand. Both suffer from special interest laws and a congress willing to not address the problems. Reforming both at once would be one way to reorganize the Federal Budget before we bleed to death.
Unfortunately, solutions require people more concerned with the country than they are their careers. Lots of luck with that.
Thanks
First is raise Medicare taxes.
Good. A good deal of funding for Medicare comes out of general revenues. Basically, the Medicare program has been raiding more and more of general funds, and most people are not even aware of it. This should be done, regardless. People should see the real cost of this program.
Second, it guts Medicare Advantage (except in FL of course).
Good. The program was a rip off to tax payers, anyway.
Third, it projects future cost increases in Medicare of 6 percent instead of 8 percent and it uses all of that money to “pay for” the new subsidies.
This, on the other hand, is a scam.
First off, today, no Medicare funding comes out of general revenues. It is projected to starting in a year or 2 but today this is not true.
Second, these Medicare taxes ARE NOT GOING TO MEDICARE. They are going to fund subsidies to purchase health insurance outside of the Medicare program. So these taxes do nothing to increase the solvency of Medicare.
If MA is a ripoff, why not gut it in Florida too. I have no issue eliminating the subsidies but again, I'd like to use the money I save to make Medicare more sustainable.
Glad you agree the last is a scam. It is the last that provides the “1 trillion in savings” that the President is so fond of talking about.
Save two copies, I'd like one too
“As long as big insurance lobby money drives any bill, even a small step like the public option is dead.”
I believe if public sentiment is strong enough (and numerous enough) against the insurers, or if things get so bad that no other alternative is seen (the point where I believe a federal system would become inevitable), that Washington would eventually respond.
Consider, too, the consequences should more and more lose insurance — swamping the emergency room more than people are doing now. Eventually, I believe, something would happen.
That's aside from fluke stuff like lawsuits or some activist ruling saying that government is obliged to provide a minimum amount of health care to its citizens.
“A good deal of funding for Medicare comes out of general revenues. Basically, the Medicare program has been raiding more and more of general funds, and most people are not even aware of it.”
Wow. I knew SMI was around 75 per cent (subsidized; “premiums” only about 25 per cent) last time I checked, and I've been reading the Trustees' Summary normally, but the Medicare report shows it's up to around 79 per cent currently.
HI and SMI have separate trust funds, sources of revenue, and categories of expenditures. Table II.B1 presents Medicare data for calendar year 2008, in total and for each part of the program. The largest category of HI expenditures is inpatient hospital services, while the largest SMI expenditure categories are physician services and prescription drugs. Payments to private health plans for providing Part A and Part B services represented about one-fourth of total A and B benefits outlays.
HI, the primary source of financing is the payroll tax on covered earnings. Employers and employees each pay 1.45 percent of wages, while self-employed workers pay 2.9 percent of their net income. Other HI revenue sources include a portion of the Federal income taxes that people pay on their Social Security benefits, and interest paid on the U. S. Treasury securities held in the HI trust fund.
For SMI, transfers from the general fund of the Treasury represent the largest source of income, currently covering about 79 percent of program costs. Also, beneficiaries pay monthly premiums for Parts B and D that finance a portion of the total cost. As with HI, interest is paid on the U. S. Treasury securities held in the SMI trust fund.
http://www.cms.hhs.gov/reportstrustfunds/downloads/tr2...
[T]he Medicare Supplementary Medical Insurance (SMI) Trust Fund that pays for physician services and the prescription drug benefit will continue to require general revenue financing and charges on beneficiaries that grow substantially faster than the economy and beneficiary incomes over time.
The drawdown of Social Security and HI Trust Fund reserves and the general revenue transfers into SMI will result in mounting pressure on the Federal budget. In fact, pressure is already evident. For the third consecutive year, a “Medicare funding warning” is being triggered, signaling that non-dedicated sources of revenues—primarily general revenues—will soon account for more than 45 percent of Medicare's outlays. A Presidential proposal will be needed in response to the latest warning
[E]xpected steep cost increases will result in rapidly growing general revenue financing needs-projected to rise from 1.3 percent of GDP in 2008 to about 4.7 percent in 2083-as well as substantial increases over time in beneficiary premium charges.
The SMI Trust Fund is adequately financed under current law because of the automatic financing established for Medicare Parts B and D. Nonetheless, projected SMI cost growth over the long term will require increases in enrollee premiums and general revenue funding that will average about 6.4 percent annually, placing a growing burden on beneficiaries and Federal revenues. Note that Part B cost projections are understated (by 18-21 percent in 2015, and by up to 10 percent in 2030 and beyond) as a result of incorporating substantial reductions in physician fees that would be required under current law, but are very unlikely to occur.
This year's Medicare Trustees Report is the fourth consecutive report in which the annual general revenue funding contribution to total Medicare expenditures is projected to exceed 45 percent within the first seven years of the 75-year projection period. The current projection is that the threshold will be reached in 2014, the same as reported last year. This result triggers another “Medicare funding warning.”
About 75 percent of SMI Part B and Part D expenditures are paid from Federal general fund revenues, with most of the remaining costs covered by monthly premiums charged to enrollees. Part B and Part D premium amounts are based on methods defined in law and increase as the estimated costs of those programs rise.
In 2009, the Part B standard monthly premium paid by most enrollees is $96.40. There is also an income-related premium surcharge for Part B beneficiaries whose modified adjusted gross income exceeds inflation-indexed thresholds (in 2009, $85,000 for individual tax filers, $170,000 for joint tax filers). Income-related premiums range from $134.90 to $308.30 per month.
In 2009, the Part D “base monthly premium” is $30.36. (Actual premium amounts charged to Part D beneficiaries depend on the specific plan in which they are enrolled and are expected to average around $28 for standard coverage.) Part D also receives payments from States for the Federal assumption of Medicaid responsibilities for prescription drug costs for individuals eligible for both Medicare and Medicaid. In 2009, State payments are estimated to cover 13 percent of Part D costs.
Part B costs are expected to be higher than projected for 2010 and beyond (understated by about 18 to 21 percent in 2015, and by up to 10 percent for 2030 and later) because the projections assume that current law will substantially reduce physician payments per service beginning in 2010. Multiple years of substantial physician fee reductions are very unlikely to occur before legislative intervention, as evidenced by Congress overriding scheduled reductions for 2003 through 2009. These understated physician payments affect projected costs for Part B, total SMI, and total Medicare.
To prevent asset exhaustion and maintain an adequate contingency reserve would require unusually large premium increases for Part B enrollees who are not subject to the hold-harmless provision (new enrollees each year and those who pay the income-related premium adjustment), as well as for State Medicaid programs that pay the full premium for dual Medicare-Medicaid beneficiaries. This method of addressing a revenue shortfall caused by the hold-harmless provision is the only one available under current law.
[T]he difference between outgo and dedicated payroll tax and premium income will grow rapidly in the 2010-30 period as the baby-boom generation reaches retirement age. Beyond 2030, the difference continues to increase nearly as rapidly due primarily to health care costs that grow faster than GDP. After the trust fund exhaustion dates (2037 for OASDI, 2017 for HI), the increasing positive amounts for OASDI and HI depict the excess of scheduled benefits over projected program income. When the statutory SMI general fund revenue requirements are added in, the projected combined Social Security and Medicare deficits and statutory general fund revenues in 2083 equal 9.7 percent of GDP. A similar burden in 2008 would have required all Federal income tax revenues, which also equaled 9.7 percent of GDP.
http://www.ssa.gov/OACT/TRSUM/index.html
Lol of course ; )