The Catskill Chronicle

By Mort Malkin

The President’s commission on Debt Reduction has said the government is heading for big trouble by living on credit. Don’t they know that’s the American way? So, the Commission looked at the numbers and saw that Medicare and Social Security accounted for many billions. What a target! Some of that money, they figured, could balance the budget. First, their spin doctors prescribed renaming Social Security and Medicare “entitlements.” The word entitlements implies getting something for nothing by dint of unwarranted influence with the government or because they represent a large voting bloc. But, Social Security and Medicare disbursements are from moneys that had already been collected as FICA taxes deducted from all the paychecks of all the workers over the years. It’s real money. Undeserved entitlements may be considered to be those government agencies and programs that bring in no money but cost a great deal. Things like:

* The State Department with its huge embassies in Iraq, Afghanistan, Saudi Arabia, Turkey, Haiti, Ivory Coast … The only one that makes any sense is Ivory Coast. How else to guarantee a supply of fine chocolate?

* The 737 (admitted) US military bases abroad.

* The 16 different US intelligence agencies. Is it redundancy, or paranoia, or turf battles?

* Assassination teams that roam around Asia, Europe, and Oceana.

* 100,000 private, gun-toting military contractors in Afghanistan, on government payroll at more than a half million dollars per individual. Mercenaries are expensive.

* Add your own favorite federal agencies that take in no money but spend what they don’t have as if the dollar was going to be devalued tomorrow.

Such government agencies and programs, not Social Security and Medicare, are the real something-for-nothing entitlements. If you are a working stiff, you know that every paycheck has FICA taxes withheld. That money goes to the Trust Funds, which invest it safely in Treasury bonds [the same Treasuries that China, South Korea, Saudi Arabia, and Kuwait hold], where it is kept until you become a senior. The FICA deductions are IOUs, not entitlements. The Social Security Trust fund is presently awash in money, about $2.4 trillion. It could pay out all its obligations to present seniors and those who join that exclusive club until 2036. This is an emergency? The Medicare Trust Fund is not so flush. It has only enough till 2024. If Congressman Paul Ryan needs to worry, let him look into the trillions in US Treasuries held by nations of the Far East and the Near East. They are already giving interviews off the record, and a few openly, proposing a different currency to pay for the annual US balance of trade deficits.

The solution to Social Security Trust Fund shortfalls after 2035 is simple. Just scrap the cap. Currently, all salaries are taxed, up to a limit of $106,000. No earnings above $106,000 are taxed at all. By withholding FICA taxes of workers’ full pay, Social Security would be safe for another millennium or two.

Medicare is a little more complex. Over the last few years, costs are rising faster than the rate of inflation. It is because hospitals and doctors are paid for services provided, such as tests to establish the diagnosis and procedures to treat the disease. Doctors are not paid to care for a population of patients in sickness and in health. So, they do lots of tests and perform a great number of procedures. Hospitals do the same, stretching out each hospital stay to the maximum. They also call in the various specialists and sub-specialists. In the last few years, medical-surgical technology has advanced faster than disease can keep up with – blood tests, echo-cardiograms, MRI studies, PET scans, hip and knee replacements, open heart surgery, organ transplants, and now genetic testing. And, if the test or medical procedure is available, no expense should be spared. Many drugs, both old and new in various combinations, are prescribed, and Medicare is charged full (exorbitant) retail price. Medicare may not negotiate savings based on volume as Medicare of Canada does.

Within the parameters of that costly system, Medicare is amazingly cost effective.

The funds paid for medical claims generate administrative expenses of only 3%. Private insurance companies typically have non-medical expenses of between 15% and 25%. But, it’s no wonder that Medicare can operate so efficiently: no million dollar salary for the CEO, no profits for the stockholders, no advertising & marketing expenses. Efficient or not, Medicare is projected to be less than fully funded by 2024.

The first fix is to ban the drug companies from advertising directly to the public. The media should not come between patients and their doctors. The next step is for Medicare to be able to negotiate drug prices in large quantities for senior citizens. Then, the final leap is to create a healthier population that doesn’t need so much medication, so much specialist consultation, or so much surgery. The government knows how to do that. CDC&P (Centers for Disease Control & Prevention) says that 70% of all chronic disease can be better controlled or even prevented by lifestyle changes such as smoking cessation, a healthful diet, and effective exercise. The last few Surgeons General – Dr. Koop, Dr. Satcher, Dr. Elders – agree. The present Director of NIH, Dr Francis Collins, not only agrees, he has changed his ways personally. He no longer orders sugar glazed donuts with mocha lattes on his coffee breaks. He gave up all the usual excuses for not having time to exercise. Dr. Collins is trying to prevent diabetes 2 – he has two genes that put him at greater risk for the disease.

It turns out that other chronic diseases, too, respond to a healthy lifestyle: hypertension and stroke, coronary heart disease, osteoporosis, several types of cancer, chronic low back pain, mental depression, and a few others. The concept of a healthy lifestyle is simple and elegant: 1) a nutritious diet that concentrates on variety, 2) regular exercise that is effective, and 3) some method of relaxation. Call it the Wellness Triad. President Obama is expert at simple and elegant – he could motivate the nation. The details of a healthy lifestyle are many, however, and require some instruction. Let the government set up lectures followed by short courses of instruction in communities across the nation. The teaching will be based on scientific principles of nutrition, sports medicine, and anatomy & physiology. No funny stuff; no mystical Eastern practices that take a lifetime to learn. Even medical meditation must be considered Western science, an outgrowth of the work of Wallace and Benson as reported in the American Journal of Physiology and the Scientific American. The health improvements from such a Wellness Triad lifestyle show up within 8 or 10 weeks.

Dr. Collins – get an audience with the President. Tell him that shooting 3-pointers doesn’t count as aerobic. He needs to advocate aerobic walking along with improved nutrition for the people. Maybe an audience with the First Lady would be better. She is not as distracted by Iraq and Afghanistan.

Now we can save Medicare and Social Security. That wasn’t so hard. The Republican Congressmen won’t have to face constituents who say “Keep you’re hands of my Medicare.” The Republicans are learning the hard way that they won’t convince the voters to privatize Social Security and Medicare or to give tax breaks to corporations and the giga-rich. Even with millions of dollars spent on TV ads that keep repeating the half truths (at most) of the corporados, the people are smart enough to vote their own interests. Imagine – countering campaign money with votes. [Just as long as all the votes are counted.] What an idea!