July 30, 2003 | Backgrounder on Health Care
The Medicare debate has focused almost exclusively on what form of drug benefit to provide to senior citizens. Lost in the debate is what the huge new unfunded liability implicit in the drug legislation would mean to American taxpayers. There are no free lunches, and future taxpayers will have to pick up the commitment to senior citizens.
The budgets of mandatory programs, such as Medicare, are classified as "uncontrollable" because the government cannot directly control how much is spent. Lawmakers merely set eligibility requirements and benefit levels, and the program's cost is determined by how many eligible individuals enroll in the program. Reducing program spending requires that Congress rewrite the eligibility and benefit levels.
Popular mandatory programs typically experience increased enrollment. This in turn creates pressure for Congress to expand eligibility to a wider constituency and increase benefit levels. With no brakes, costs soar, forcing Congress either to raise taxes or to reduce benefits.
The uncontrollable, unknowable costs of mandatory programs explain how Medicare could be created in 1965 based on a projected annual cost of $10 billion and end up costing $244 billion by 2003. Medicare spending is on pace to double in the next decade, and that growth rate will accelerate when the baby boomers begin retiring. With the payroll tax insufficient to fund Medicare's costs, the program will run a $5 trillion deficit through 2030.
Adding an expensive new drug benefit will substantially worsen Medicare's already shaky finances. Estimating the long-term cost of a drug benefit is difficult, but it would be irresponsible for Congress to create this benefit without attempting to calculate its long-term costs and producing a credible plan to pay for it.
The 10-year cost estimates performed by the Congressional Budget Office (CBO) do not capture the substantial cost that will likely be felt by taxpayers in 15, 20, and 30 years. This paper estimates those costs.
The Total Shortfall
Like the CBO, the authors estimate that the current Medicare drug bills would cost approximately $328 billion over the next 10 years ($400 billion without adjusting for inflation). Yet costs accelerate substantially beyond the 10-year budgeting window. In the following 10 years, from 2014 through 2023, the drug benefit is projected to cost $772 billion. That rapid growth rate continues through 2030.1
What the Shortfall Means for Taxpayers
When the baby-boom generation enters Medicare and causes it to plunge deeper into the red, Congress will likely use deficit spending to fund the shortfall. Deficits, however, must eventually be repaid through either taxes or fees. Lawmakers will likely resist massive increases in Medicare premiums, leaving the taxpayers to cover the $5 trillion Medicare shortfall as well as the $2 trillion shortfall created by a drug benefit. The effects of the combined shortfall on two typical households are detailed below.
This couple already pays the 15.3 percent payroll tax to fund current Medicare (and Social Security) beneficiaries. Because the payroll tax will not provide enough revenue to fund Medicare for all retirees, this couple also faces $39,894 in additional taxes between now and their own retirement in 2030.
The proposed Medicare drug benefit will add $16,127 to that tax burden, but none of these taxes--neither the payroll tax, the tax need to fund the current Medicare shortfall, nor the tax needed to fund a drug benefit shortfall--will be set aside for their own retirement. Every dollar will fund spending for current Medicare recipients.
By age 27, the child has likely married, begun a career, and started a family--and inherited an overwhelming tax burden.
In 2030, when the child is 27, the person's household would pay $1,125 in taxes just to cover the unfunded drug benefits of seniors. This is in addition to the 15.3 percent payroll tax, plus the $2,855 in additional taxes needed to cover the shortfall in the current Medicare program. These taxes will increase rapidly over the next 40 years before this person's own retirement.
Adding this into Medicare's current projected shortfall, the total becomes:
How Such New Taxes Could Be Levied
Taxpayer funding of the Medicare drug benefit shortfall would require raising individual income taxes by approximately 5 percent through 2030. Raising that amount of income tax could be done in one of the following ways or some combination of them:
What Congress Should Do To Avoid This New Tax
Most seniors already have private drug coverage. Thus, targeted help to those who need it would make much more sense than a large new unfunded drug benefit for all seniors. Moreover, the absence of drug coverage in today's Medicare program is the result of deficiencies in the way Medicare benefits are modernized over time.
Currently, revising key benefits takes an act of Congress. It would be much more sensible to enact reforms that allow revised benefits, such as drug coverage, to be introduced into Medicare gradually over time, paid for with changes in other less valuable benefits, and done so in a way that reflects the preferences of seniors. The best model for this is Congress's own health plan, the Federal Employees Health Benefits Program (FEHBP). In the FEHBP, market competition and consumer choice leads to plans that reflect enrollee needs.2
Congress should address the needs of some seniors for drug coverage in a way that preserves two critical principles:3
President George W. Bush and many in Congress cite tax relief as the centerpiece of their economic agenda. Lawmakers who vote for the Medicare drug benefit are voting for a $2 trillion tax increase. Responsible lawmakers who oppose such substantial tax increases should look beyond the 2004 election and examine the burden that a Medicare drug burden will impose on future generations.
Brian M. Riedl is Grover M. Hermann Fellow in Federal Budgetary Affairs in the Thomas A. Roe Institute for Economic Policy Studies, and William W. Beach is Director of the Center for Data Analysis, at The Heritage Foundation.
The 2003-2030 annual cost estimates for the current Medicare program and for the Senate's proposed drug benefit come from data produced by Dr. Andrew Rettenmaier and Dr. Thomas Saving, respectively Executive Associate Director and Director of the Private Enterprise Research Center at Texas A&M University. Dr. Saving also is one of two public trustees of the Social Security and Medicare trust funds. Dr. Saving's projections of Medicare costs as a percentage of taxable payroll were converted into nominal and then real dollars using the economic projections of the 2003 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Disability Insurance Trust Funds.4
The tax cost was converted into percentage income tax increases based on projections of future baseline tax revenues from the Global Insight U.S. Macroeconomic Model and supporting Global Insight databases.
The methodologies, assumptions, conclusions and opinions in this report are entirely the work of Heritage Foundation analysts. They have not been endorsed by, and do not necessarily reflect the views of, Dr. Saving or the owners of the Global Insight U.S. Macroeconomic Model.
2. See Robert E. Moffit, Ph.D., "A Road Map to Medicare Reform: Building on the Experience of the FEHBP," Testimony before the Special Committee on Aging, U.S. Senate, May 6, 2003, at www.heritage.org/Research/HealthCare/test050603.cfm.
3. See Stuart M. Butler, Ph.D, "The Crucial Elements of an Acceptable Medicare Bill," Heritage Foundation Backgrounder No. 1667, July 16, 2003.
4. Located at www.ssa.gov/OACT/TR/TR03/index.html.