Means Testing, for Medicare

The NY Times had a piece on "Means Testing" for Medicare last week that I think is very topical for our group. It brings up an issue that is potentially one of the greatest domestic political liabilities, and one that almost every politician has been avoiding. As the NY Times’ Tyler Cowen points out, none of the healthcare reform proposals by the presidential candidates (nor most of the Congressional candidates either) even identify Medicare solvency as a problem, let alone have a proposal for a fix.
The use of “Means Testing” — cutting back on payments to the relatively wealthy, has been a proposal that has been around for a while, but, as the is pointed out:

The biggest problem with such efforts is measuring and enforcing the rules that establish who receives a specified benefit and who doesn’t. Means testing in Medicaid causes many people to hide income and assets or to transfer assets to family members, so they can look poorer and still get benefits.

And...

Of course, the idea of cutting some government transfers provokes protest in some quarters. One major criticism is that programs for the poor alone will not be well financed because poor people don’t have much political power. Thus, this idea goes, we should try to make transfer programs as comprehensive as possible, so that every voter has a stake in the program and will support more spending.

Although I agree with Mr.Cowen that this Medicare issue needs to be addressed. I completely disagree with his point that:

Advocates of health care reform tend to be long on ideas for expanding care and access, but short on practical solutions for cost control. The argument is often made that single-payer health care systems in Canada or Europe are cheaper than health care in the United States. But Medicare is already a single-payer plan, yet its costs are unsustainable.

This, as we have previously pointed out, mislabels current Medicare as a public, single payer plan. In fact, current Medicare is a complex hybrid that is as much private as it is public. It should never be mistaken as a "single payer" system.
The fact is that a single payer system would take care of this aspect of spending by rationing services as the economic status sees fit. The issue is how to make sure that this rationing is done in a way that allows for the best health of the nation, yet does not restrict access to services to those who would like to pay for them out-of-pocket or through private insurance.
This is where the HPfHR plan has a solution: every one is covered for basic services while allowing for "means testing", preventive services incentives and other methods to improve efficiency while improving the health of the nation.
Gil