Ready for a substantive debate on Medicare?

I’d like to think that the selection of Paul Ryan as Mitt Romney’s vice presidential candidate could lead to a substantive, adult debate on Medicare for the general election. I’m pretty sure that’s not going to happen, but I do think it will at least get Medicare on the table, where it belongs.

From my perspective a substantive debate would include at least the following topics:

  • Current and projected sources and uses of funds for Medicare. It should be made clear that Medicare is not self-financing today, with close to half of funds coming from general revenues
  • Whether and to what extent Medicare should be means-tested for people with certain levels of wealth an income
  • Medicare’s impact on intergenerational equity, considering that it’s largely the young paying for the care of the old
  • How to preserve the benefits of Medicare while making the program more cost effective
And since Ryan’s entry signifies the season of radical proposals, here’s one I’d like to have us consider:
  • Continue to offer unlimited Medicare coverage during a person’s lifetime, but have the estate pay back the difference between what the person contributed during their working years and what was expended on their care



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