We HAVE to be realistic about how much we are actually paying in to the system. In the interest of putting some perspective in this, I’ve done some hard (unpaid) work:  Let’s assume a worker, 54 years old today, has worked since the age of 16, and he will work until the age of 65, for a total of 49 years.  Born in 1958, he started working in 1974, mowing lawns for a landscaping company, paid minimum wage, which was $2/hour. He worked after school and one weekends during the summer for a total of 20 hours a week, and after this initial job he continued working 20 hours a week at minimum wage (which rose to 2.10/ hour in 1975) in various jobs until he finished high school at the age of 18. He worked 20 hours a week for 52 weeks at $2 per hour, earning $2080. He worked 20 hours a week for 52 weeks at $2.10 per hour, earning $2184. He earned a total of $4264 for those two years. He and his employers paid into medicare 2.9% or $123.66.  In 1976 he went to college and continued working part-time but for 30 hours a week, still earning minimum wage, which had by then risen to $2.30 per hour. He earned this for his first year, then his wages increased to 25 cents more than minimum wage every year while he finished his four year degree in engineering. In 1977 he earned $2.55 per hour. In 1978 he earned $2.90 per hour. In 1979 he earned $3.15 per hour. In 1976 he earned $3588. In 1977 he earned $3978. In 1978 he earned $4524. In 1979 he earned $4914. He earned a total of $17004 during those four years. He and his employer paid into medicare 2.9% or $493.12.  In 1980 he got an entry level position at a firm with a starting salary of $21,000 a year. In 1985 he received a raise, earning $30,000 a year. In 1989 he received another raise, earning $41,000 a year. In 1994 he received another raise earning $58,000 a year. In 1998 he received a raise, earning $70,000 a year. In 2001 he received a raise, earning $80,000 a year. In 2004 he received a raise, earning $86,000 a year. In 2007 he received a raise, earning $91,000 a year. In 2010, after 30 years with the firm, he received a raise, earning $100,000 a year. In 2012, at the age of 54, he received another raise earning $106,000. Next year he will be made President of the firm and he will earn $150,000 a year every year until he retires at the age of 65 (I sincerely hope I haven’t done any of my math wrong).  1980-1984 five years at 21000, total $105,000, =$3045 paid to medicare  1985-1988 four years at 30000, total $120,000, =$3480 paid to medicare  1989-1993 five years at 41000, total $205,000, =$5945 paid to medicare  1994-1997 four years at 58000, total $232,000, =$6728 paid to medicare  1998-2000 three years at 70000, total $210,000, =$6090 paid to medicare  2001-2003 three years at 80000, total $240,000, =$6960 paid to medicare  2004-2006 three years at 86000, total $258,000, =$7482 paid to medicare  2007-2009 three years 91000, total $273,000, =$7917 paid to medicare  2010-2011 two years 100000, total $200,000, =$5800 paid to medicare  2012 one year 106000, total $106,000, =$3074 paid to medicare  2013-2023 eleven years at 150000, total $1,650,000, =$47,850 paid to medicare.  In 2023 when he retires at the age of 65, he will begin to use the medicare system. Over the lifetime of his work, he will have contributed only $104,987.78. At 65 he is very healthy and will only use a moderate amount of care, which will increase as he ages until he dies at the age of 82 after using medicare for 17 years.  In 2005, medicare paid roughly half of a person’s medical expenses. Total expenses were on average $14,471, of which medicare paid $7,064 per person annually. If we could somehow stabilize the system and assure that the cost of health care maintained its 2005 rate (HA! HA!), Medicare would spend $120,088 on our subject over the remainder of his life, and he would need at least that much more in other insurance coverage and savings in order to pay for what medicare does not cover, because medicare does not cover everything in the first place and never has.  Note that this subject has had much better than average success in life, achieving the top status in his field and maintaining top salary for over a decade. The majority of the nation will earn much less than that, with the national median household income being only $51,00. If a person earned a stable $51000 a year every year for 49 years that our subject worked, he would earn $2,499,000 over his working lifetime and contribute only $72,471 to medicare, yet he will take from medicare the same $120,000 or more in his retirement. In 2010, payroll contributions covered roughly only 40% of costs in medicare parts A, B and D, or only 85% of part A. The rest comes from general revenue, beneficiary premiums (part of the cost the individual has to be able to cover in their old age), and very small percents from states, taxation on social security benefits, and interest (interest covers only 4% of costs, but how can we earn interest when there’s no principle).  The fact of the matter is we are not paying into the system as much as we take out and there are not enough workers earning wages that are high enough to cover the gap. Until we control the cost of the care itself, we will not be able to bring this under control.  Ryan’s idea of giving people vouchers at $15,000 a year to purchase private insurance is not that bad an idea. It takes the money out of the government’s hands. A private insurance company is going to have better oversight and come down harder on fraud, waste and abuse within the system, which has run rampant under government control. It puts more of the truly ill into the general insurance pool system so that private insurance companies work harder to control costs of the most expensive and necessary services. The government having primary control of the end of life insurance system was meant to control those costs, but instead there has been a meteoric rise in the cost of care, going from $160 a year costs per person on average in the 1960s to over $8,000 a year today per person on average—remembering that the older, sicker population is utilizing care at the rate of more than $14,000 a year (I think it’s around $16,500 a year right now); in 2009, half of medical care costs were to cover only 5% of the population—the sickest, but Medicare did not cover all of the sickest, which leaves so many in the general population without coverage or with waning coverage. It also makes the consumer more aware of the value of their care, personally. We have this tendency to believe we’ve “paid in all these years and should get back what we’ve given”—well, we do get back what we’ve given and then some, and because we’re not in control of it, we don’t necessarily pay attention to what we’re spending and how. By removing the vast majority of the chronically ill from the private insurance system (yes, most elderly have supplemental insurance, but it is still a different system altogether, and there is a guaranteed payer of half the costs in the government through medicare), we actually caused the private insurance industry to unrealistically charge healthier patients for much more care than what they were actually receiving, which meant that the cost of ordinary care could rise arbitrarily, because there was more money available to spend through insurance on those healthy patients as people wanted more value for their dollar, this being care for which they would normally have paid for themselves, while at the same time punishing people who got truly ill but could not qualify for medicare because their expenses were so much greater than the average of those paying in to the pool. Health insurance itself lost its purpose with the shift to medicare as a primary provider for elderly patients as the majority of the chronically ill.  The thing is, we don’t have many choices for really fixing things. The healthcare industry does not want to go to universal care because they don’t want to become government employees—they like their increasing wages as capitalists too much and the leeway they have not being constantly under someone’s thumb. We need more doctors already (another problem—self-created by caps on number of med students—which contributes to rising costs because it assures increased demand), but if we were to go to universal care, caps on wages would be instituted, which might make the more intellectual and better suited to doctoring individuals shy away from a the medical field—we need more doctors, but not a dumbing down of the field. Furthermore, making our doctors and nurses essentially government employees means they will strike when they don’t like something (which is immoral and unethical for someone in the medical profession, as you are gambling with the lives of people you are meant to protect, but I digress). So universal care has some downsides.  If we do not move the truly ill back into the general medical insurance population so that the control of costs becomes even, then medicare should be expanded to cover everyone with chronic illness, no matter their age or income, 100%. Medicare taxes should be raised to 6.5%. More doctors should be hired, with requirements for service as primary care physicians as part of the training, and at the same time we should pay for their college so that they don’t start with $200K in debt (this is a trade for time served as primary care when they would all prefer to be cardiac specialists) (by the way, this should be done whether or not we change medicare to a voucher for private insurance program). Private insurance should not be provided by employers any longer and should only cover non-chronic illnesses not covered by medicare, so that private insurance would become a luxury item in which everyone is pooled as individuals, rather than a necessity where some people get better rates than others. By doing this, medicare has 100% of control over the cost of chronic care and can bring cost of care into check across the nation (this is dangerous because each state has an independent economy, which is a good reason for states rights to come into play, though I know liberals don’t like to think about states rights). In other words, chronic care becomes completely universal across the nation, and ordinary care remains capitalist—the two become totally separate, instead of intermixing only partially, which is the true source of the catastrophic rise since the advent of medicare, in my humble opinion.  Ryan’s plan, in essence, would be to put all of the chronic illnesses into one basket on the capitalist side of things, through private insurance, in order to control costs by actual supply and demand, where everyone is cost-sharing the cost of the truly ill in one system that can still fluctuate based on needs and doesn’t open the door to striking doctors and nurses.  One way or another, until we are willing to understand that most of us really do not pay very much in to the medicare system, we can’t really have an honest conversation about what needs to happen. We have to have a realistic understanding of our own contribution and how much we can expect to take from the system. We don’t pay very much in. We get way more out than we contribute. And we are all expected to pay at least half our keep even when we’re on medicare, because it already doesn’t cover 100%. Keep in mind that’s all on average. A perfectly healthy person might pay more into the system than they ever take out before they die peacefully in their sleep, but in this day and age, that doesn’t happen too often. More often, the terribly ill take their fair share and then the fair shares of six others. I wonder how many of us have actually sat down to do the math on how much we’ve individually contributed. There are some people (like me, a writer and at-home parent) who have paid in hardly anything (I haven’t worked for pay in almost 16 years). What do we say to people like that (like me) when they talk about their fair share?  Medicare payments averages 2009 www.kff.org/medicare/upload/7305-04-2.pdf  Engineering salaries historical progressive www.tms.org/pubs/journals/jom/9505/beazley-9505.html  PS If there are errors, I do apologize. What more do you want for two hours unpaid labor??
OXFORD, OH -- Appearing at his alma mater Wednesday, Republican vice presidential nominee Paul Ryan weighed in on the Medicare debate for the first time before voters on the campaign trail. “The president, I'm told, is talking about Medicare today,” Congressman …