thebigp

Reforms to Medicaid must be similarly geared to enabling a more competitive and consumer-driven health sector. The core structure of the program—in which states are reimbursed by the federal Treasury for the money they spend on behalf of beneficiaries—creates incentives for overspending and inefficiency. A more effective and sustainable Medicaid program would be divided into its two distinct beneficiary groups—able-bodied adults and their children on the one hand and the disabled and elderly on the other. The federal government would then make fixed, per-capita payments to the states based on historical spending patterns for the program’s two population groups.
States would be given a lot of room to manage the program within those bounds. Ideally, able-bodied adults and children who are eligible for Medicaid would receive their benefits as a credit for buying health insurance in the private insurance market. And states would be allowed to implement major changes in the structure of the program to address their distinct needs and priorities without requiring cumbersome prior federal approval. In essence, the federal government would act as the provider of a set, defined financial contribution while the states serve as program designers and regulators, and beneficiaries themselves are empowered to make more choices in coverage and care.
The common thread linking these approaches to the largest entitlement programs is a desire to distinguish means from ends so that the misguided designs of our entitlements today are not confused with their appropriate goals. By thinking through the goals while understanding the immense fiscal pressures these programs create, we might see our way to an entitlement system that could be made sustainable in 21st-century America, could particularly help those who need it most while providing a baseline of support for the elderly in general, and could avoid undermining the country’s capacity for growth and prosperity. That combination of goals, rather than a commitment to ignore enormous and obvious oncoming problems, ought to serve as a basis for some bipartisan consensus.
Taking Responsibility
These are, to be sure, only the outlines of reforms to our major entitlement programs. But they draw upon many years of work and scholarship, especially by right-leaning experts, and are available to policymakers in various forms that can be adjusted to meet fiscal, practical, and political necessities.
Attempting any such changes would involve expending political capital. And Republicans should also be willing to trade some such changes for modest tax increases that Democrats might demand in return for their assent—especially if these are tailored to minimize the obstacles they pose to growth. The spending side of the ledger is where the real problems are, but revenue matters too, and no particular tax rate is sacred.
What should be nearly sacred to policymakers is their obligation to avoid avoidable disasters and to reduce the risk of crisis. Such basic responsibility is essential to leadership, and there is no excuse for shirking it year after year. That such recklessness is now thoroughly bipartisan only makes it more dangerous to the country. And the fact that similar irresponsibility abounds at the state and local levels (where many pension plans are one market crash away from catastrophe) makes it all the more so.
The Trump era has distracted many politicians and citizens from these problems, as it has from many other perennial challenges of governing. On the right in particular, many people who seemed genuinely concerned about deficits and debt 10 years ago now pretend these challenges don’t exist. But ignoring them doesn’t make them disappear. In fact, it makes them worse. Viable, politically tolerable solutions are still possible, but they only grow more difficult as the years pass. It’s time to take deficits, debt, and entitlement reform seriously again.
SOURCE--Yuval Levin and James C. Capretta—wky std Bernie Sanders speaks about saving Social Security, Medicare and Medicaid.
Bill Clark/CQ-Roll Call,Inc.

Lonewolf

We should have a year of jubilee like in the bible all debt forgiven let the little guy win once!

Liberty Tree

Everything should be on the table. Every department could absorb a cut just in better management and reducing administrative costs.

Comment Loc: California

Too many people are ripping the system. I know of a mom with a 1 yr old. Mom quit her job. Her live-in male works for cash. The whole family is on Obamacare, food SNAP and cash welfare. She is already pg again and taxpayers will pay $10,000-$20 thousand delivery costs. With the millions of i******s crossing the border. They are guaranteed food, medical care and welfare and housing. Kids don't sleep on the streets. Well, maybe in San Francisco. Giving 100s of millions of people a blank check to pay for their meds is only asking to rip off taxpayers. There has to be controls. Remember, Obama doubled the National Debt from 10.5 trillion to 21 trillion. Obama pilled up more National Debt than all preceding 43 presidents combined before him. A judge on the 9th circuit court an Obama appointee has stopped the xl pipeline saying it had to have a new EIR after Obama held it up for 8 years. I hope Trump takes this judge to the SCOTUS where conservative majority will shot this liberal gang bnger in the foot.

lpnmajor Loc: Arkansas

Do some actual math. #1. Social Security and Medicare are not entitlements, they are annuities/insurance. Is Bluecross/Blueshield an entitlement program?

#2. Welfare costs 14% of the annual budget - Federal Retirement/Defense/non contributory health costs 67% of the budget. Now, where would it make sense to cut costs to eliminate deficits?

Lonewolf

If we stopped bombing for 2 weeks it would pay most programs

promilitary

I have a simpler solution. Get rid of congressional pensions.

Lonewolf