Which is Harder: Medicare or Social Security?

Eli Lehrer’s intuition is actually the opposite of mine:

In many ways, Medicare and Medicaid may actually be easier to modify than Social Security.  Those programs would still be able to accomplish their fundamental goals after reform. Most reform proposals for Social Security however would change the system fundamentally.

It seems the exact opposite to me. Social Security provides people with cash payments, that are linked in one way or another to inflation.  They of course would rather have higher benefits than lower ones, and there will be consternation as we debate any reform of this program.  However, if a specific Social Security compromise were agreed to (specific increases in revenue and/or decreases in benefits), then we could expect it to work more or less as expected.  And people would have a reasonable understanding of what benefits they would receive.  That is actually one of the benefits of fixing Social Security, because once fixed it really could be fixed and off the table.  Medicare is an entirely different animal because it purchases health care for beneficiaries, including innovations tomorrow that are unknown today.  And there is another very interested party to every Medicare transaction, namely providers.  Every dollar of waste, inefficiency and inappropriate care that is squeezed out of Medicare by whatever means is a reduction in someones income.  They won’t go quietly.  A real Social Security reform could be passed this year and put on auto-pilot.  Any Medicare reform will require endless tinkering; we will never be done with health care reform.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

One Response to Which is Harder: Medicare or Social Security?

  1. Floccina says:

    People do seem a to like SS a little more that Medicare.

    BTW I think that the only reason to address SS now is that it would allow us to lower the SS tax (FICA). The way I see it SS is a pay as you go welfare program and so as long as it is not in the red now there is no problem with it except that young people trying to start families are over taxed to give more to rich and middle class people over 65. The fact the republicans are scaring people about SS is not sufficient reason to mess with it.

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