Entitlement Reform Proposed Topic for the 2012-2013 High School Policy Debate Topic For the National

Federation of State High School Associations

Tim Alderete Joshua Reisman Isabella Lee Theo Kwan Aaron Novick The Meadows School

1. Summary

Title: Entitlement Reform A proposed topic for the 2012-2013 High School policy debate topic topic. Recommended Resolutions: 1. Resolved: the United States federal government should substantially reduce its spending for Medicare and/or Social Security. 2. Resolved: the United States federal government should substantially reduce Medicare and/or Social Security spending. 3. Resolved: the United States federal government should substantially limit the growth of Medicare and/or Social Security spending. 4. Resolved: the United States federal government should substantially reduce Medicare and/or Social Security benefits. Types of affirmative cases: Affirmative teams would have a wide range of options for plan mechanisms. Reducing benefits, reducing Who Gets benefits, reducing administrative costs, or limiting what type of medical procedures benefits will cover all are Areas for different cases, with multiple specific plan mechanisms in each Area. Other affirmative teams will opt for privatization schemes. Finally, teams can choose to phase out entitlement spending entirely. Affirmative advantage areas will focus on the long term financial stability of the US government, with the attendant economic and national security implications. Teams can also claim advantages related to health and poverty from preventing system collapse. Kritikal affirmatives can focus on the ethical concerns about mandatory government programs and taxation. Types of negative approaches that would be utilized: The negative will be assured of ground related to restricting spending or benefits. This carries with it economic and retirement security impacts. Negatives will have substantial opportunity to address the system collapse through a powerful set of counterplans, from employment promotion, to restructuring, to increasing tax revenue, as well as other forms of entitlement reform that compete within the literature. The political backlash disadvantage will be the most important on the topic. Debatability of the topic: For the Negative, there would be a significant amount of Mechanism Predictability, as there is a direction to the resolution. The advantage ground is more limited, but is very deep and balanced. The literature base for both sides is enormous. The potential impacts are comparable in size, scope and interest.

Paragraph Synopsis: Government debt is rapidly increasing. The primary cause is the structural growth of entitlement spending. Programs like Social Security and Medicare, which for decades have produced surpluses that were directed into trust funds, soon will start to produce deficits. Insufficient funds were placed in trust, and those trust funds were used to finance government discretionary spending. The retirement of the Baby Boomers will break both systems, and push government deficits and debt beyond stable limits. Within fifty years, all government revenue from taxes will be needed to cover entitlement benefits and the interest on the debt owed to their trust funds. We will be forced to either dramatically cut all non-entitlement spending, or tax industries out of business. We have time to begin reform now, and phase in gradual changes and spread out costs over a half of a century, but we must begin now by reducing spending. No amount of administrative shuffling or revenue increases can overcome the structural increases in benefits. Affirmatives would specify types of cuts to make, or may choose to phase out the system in favor of privatization. The negative will be able to defend the promise that the government has made over the years to protect its citizens in their retirement, and the benefits that they have invested into for their entire lives.

2. Introduction:
Social Security and Medicare are retirement security programs that aim to guarantee a basic level of income and medical care for persons after retirement, on disability leave, or for survivors of retirees. They are funded by a combination of dedicated taxes, general federal revenues, premiums and trust funds. The mandatory nature of the taxation and the guaranteed nature of the benefits have caused these programs to be called entitlements. This is also known as Mandatory Spending or Direct Spending (although those are a bit broader concepts they include debt payments). The federal budget includes Mandatory Spending and Discretionary Spending, which means everything that is not an entitlement or direct spending. Paul Johnson, professor of Political Science at Auburn University, defines them as the kind of government program that provides individuals with personal financial benefits to which an indefinite . number of potential beneficiaries have a legal right (enforceable in court, if necessary) whenever they meet eligibility conditions that are specified by the standing law that authorizes the program. For decades, workers have paid into these programs, with taxes deducted from their paychecks, with the expectation that when they retire, they will receive the benefits that they are entitled to. That is the promise. Medicare has four different parts which cover different aspects of retirement health care through different means. The Report by the Center for Medicare Service Board of Trustees explains the different aspects: The Medicare program has two components. Hospital Insurance (HI), or Medicare Part A, helps pay for hospital, home health, skilled nursing facility, and hospice care for the aged and disabled. Supplementary Medical Insurance (SMI) consists of Medicare Part B and Part D. Part B helps pay for physician, outpatient hospital, home health, and other services for the aged and disabled who have voluntarily enrolled. Part D provides subsidized access to drug insurance coverage on a voluntary basis for all beneficiaries and premium and cost-sharing subsidies for low-income enrollees. Medicare also has a Part C, which serves as an alternative to traditional Part A and Part B coverage. Under this option, beneficiaries can choose to enroll in and receive care from private Medicare Advantage and certain other health insurance plans that contract with Medicare. The costs for such beneficiaries are generally paid on a prospective, capitated basis from the HI and SMI Part B trust fund accounts. The 2011 annual report of the Board of Trustees of the Federal Old-age and Survivors Insurance and Federal Disability Insurance Trust Funds explains the structure of the Social Security Program: The Old-Age, Survivors, and Disability Insurance (OASDI) program in the United States makes available a basic level of monthly income upon the attainment of retirement eligibility age, death, or disability by insured workers. The OASDI program consists of two separate parts that pay benefits to workers and their familiesOld-Age and Survivors Insurance (OASI) and Disability Insurance (DI). Under OASI, monthly benefits are paid to retired workers and their families and to survivors of deceased workers. Under DI, monthly benefits are paid to disabled workers and their families. Opposition to Social Security and Medicare has existed from their very establishment. Critics oppose the expansion of government-run medical and retirement insurance markets, the mandatory taxes, and the lack of choice that comes with a uniform program. While this opposition is heartfelt and continuing, Medicare and Social Security have become some of the most popular government programs, with extremely powerful constituencies. This has muted outright criticism of the programs, and has made discussion of reforms taboo, as the Third Rail of politics.

A different criticism, one that began in the early 1980s, but has gained substantial traction recently, is that the programs must be reformed in order to Save them that they are financially unstable, and will eventually collapse unless something is done now. A variety of different explanations for the financial shortfall exist from a demographic shift toward a retiring and aging population, to rising health care costs, to intergovernmental debt. Whatever the cause of the financial problems, it is no longer taboo to call for reform. The Affordable Care Act [Obamas health care legislation] enacted substantial changes to Medicare benefits, Representative Paul Ryan introduced legislation to overhaul Medicare by offering vouchers for private programs, prominent Republicans have declared that they will not vote to raise the debt ceiling unless major reforms to entitlement spending are adopted, and Senate leadership has indicated that they are open to discussing the issue. CNN reports this month that even lobbying groups for seniors, like the AARP, have communicated to Congress their interest in reforms to Social Security that reduce benefits. [AARP expects Social Security benefit cuts, Jeanne Sahadi June 17, 2011] Once the Third Rail of politics, reforming Social Security and Medicare has become the Litmus Test for political maturity in coming years. While the universal opposition reform has changed, this does not mean that real reforms will pass soon. Despite a quick start and vocal support from fiscal conservatives, many Republicans are backing away from supporting any reforms that would reduce Medicare benefits. The Special Election in fill New Yorks 26th District has been called a forecast of voter reaction to changes in Medicare. Hochul's capture of a seat held for decades by Republicans forecasts, they [Democrats] say, the public's reception to the Medicare overhaul championed by House Republicans. Lawrence Hunter of the Social Security Institute believes that long-range entitlement reform and balanced budget amendments should be off the table in budget and debt-ceiling discussions they are a bridge too far under the current circumstances, unobtainable under the current political power configuration. He continues that unless Congress is willing simply to cut current entitlement benefits, no serious entitlement reform can help the deficit/debt situation in the short run. [Hunter 2011 Rules for Reforming our Bloated Welfare State] The most prominent advocate for change has been Congressman Paul Ryan. Rep. Ryan has proposed legislation that would change Medicare into a voucher, which would be used to purchase private health insurance, such as a Health Savings Account (HSA). According to Ryans plan, younger workers, once they have reached the age of eligibility, will be given a Medicare payment and a list of guaranteed coverage options from which they can then choose. Moreover, all potential savings allocated to the current health care law would go to shoring up Medicare, and not for new forms of entitlements. The budget also offers a strategy of fixing the current Medicare physician payment formula. It provides a reimbursement system that compensates physicians who treat Medicare beneficiaries. Ryan proposes what he calls a premium-support model. This premium-support model would operate in a way similar to the way the Medicare prescription-drug benefit program works now. The Medicare premium-support payment would be paid, by Medicare, to the plan chosen by the patient, thus subsidizing the cost. The payment would be adjusted so that wealthier beneficiaries would receive a lower subsidy, the sick would receive a higher subsidy if their conditions worsened, and lower-income seniors would receive additional assistance to cover out-of-pocket costs. Health plans that choose to participate in the exchange would have to offer insurance to all Medicare beneficiaries. All seniors would have the choice to opt into the new program once it begins in 2022. Ryans proposal does not address Social Security. Ryans proposal also adopts significant reforms of Medicaid. In Obamas reaction to Rep. Ryans budget, Obama recommitted to healthcare reform, declaring that the savings his plan would seek from Medicare and Medicaid would be a result of consolidating and advancing the cost control initiatives included in the Affordable Care Act and the goal, he said, is to lower the cost of healthcare, instead of reducing the level of government commitments to the elderly and the poor. Obamas plan would keep Medicare a government program but give a panel of experts

the power to force cuts if spending exceeded a certain target. His proposal would strengthen cost curbs that are already in the new health care overhaul. Also, Obama calls for cuts in Medicare payments to service providers if spending increases by more than the overall growth of the economy and an additional cushion.

3. Affirmative Ground:
Harms: The core issue addressed by this topic is the fiscal insolvency of the US federal government. Debt and deficits are rising, and the prime reasons are Medicare and Social Security spending. There are several reasons that Medicare and Social Security spending costs are rising. First Demographic shift. When these programs were established, the majority of the American population was younger. Larger percentages of the population were employed, and therefore were paying into the system, through dedicated payroll taxes. This was the Baby Boomer generation. Current demographic trends, however, show a substantial shift to an older population, where a higher percentage of the population is retired. This means that the number of people paying into the system has decreased, while the number of people receiving the benefits of the system have increased. Second Rising Medical Costs. Health care inflation has far outpaced the national rate of inflation. Medicare costs are directly affected by health care costs, because it is a fee for service program. If the cost of a medical procedure rise, so do the Medicare reimbursements. The Congressional Budget Office has examined the causes of rising Medicare costs and focuses on medical inflation: Although the aging of the population is frequently cited as a major factor it accounts for a modest fraction of the growth that the Congressional Budget Office (CBO) projects. The main factor is excess cost growthor the extent to which the increase in health care spending for an average individual exceeds the growth in per capita gross domestic product (GDP). [The Long-Term Outlook for Health Care Spending 2007 http://www.cbo.gov/ftpdocs/87xx/doc8758/MainText.3.1.shtml#1068889] Third Intergovernmental Debt. During the first decades of the programs, when there was a surplus of money coming into the programs due to the younger population, those surpluses went into Trust Funds for the programs. The idea was that these Trust Funds would cover the shortfalls during the years when there were more recipients than payees. Unfortunately, the Social Security Trust Fund has been manipulated to fund deficit spending during those years. The assets currently in the trust funds are Treasury Securities IOUs from the federal government that become a part of our annual debt servicing. This means that when Trust Fund monies need to be used to cover short falls when dedicated payroll taxes can no longer cover benefits, general federal revenues will need to be appropriated to cover those shortfalls and to service the debts on the Treasury Securities. The concern is that those increased general revenue costs will swamp any money available for Discretionary Spending. Jim Powell 2010 - the Cato Institute [A Flashpoint for Social Security http://www.cato.org/pub_display.php?pub_id=12094 On August 5th, Social Security trustees released their report showing that permanent annual Social Security deficits will begin in 2015 Since there are more than 50 million Social Security beneficiaries, and their numbers are growing faster than the number of taxpayers, there will be intense, politically irresistible pressure to continue paying benefits by raising payroll taxes and income taxes. But taxes won't be enough to save Social Security, because Medicare and Medicaid are also going broke, and payments on all the debt are skyrocketing. Social Security was set up to have each person pay for somebody else's benefits. Current payroll taxes go to pay current Social Security benefits, and nothing is set aside for the future retirement of people working now. In the past, when current payroll taxes exceeded current benefits, the Social Security Administration used the surplus to buy special issue U.S. Treasury bonds. The surplus was mingled with the government's general funds and immediately spent on other programs. Now that Social Security is

in deficit, the Social Security Administration will start redeeming those bonds, and the Treasury will draw on current revenues other than payroll taxes. The money is long gone. There is no investment fund, no lockbox. The impacts to this shortfall will be enormous, both in their impact on the economy and on our national security. Entitlement programs are spending beyond the point of collapse. James Dorn 2010 [The Real Costs Of Social Security http://www.cato.org/pub_display.php?pub_id=12082 From that vantage point, "the crisis is upon our doorstep," said Sen. Judd Gregg of New Hampshire, the ranking Republican on the Senate Banking Committee. On a 75-year basis, Social Security is bankrupt: Promised benefits far exceed estimated revenues, and if all future benefits beyond this time frame are included, the unfunded liabilities are nearly $16 trillion. If Medicare is included, the unfunded liabilities soar to more than $100 trillion. That's the amount in today's dollars that is needed to pay off all future benefits over and above taxes collected . President Obama's debt and deficit commission cannot afford to ignore these massive contingent liabilities and the need for real reform. Doing so will only compound the debt crisis. The debt crisis is an economic calamity it will destroy our economy through skyrocketing interest rates and Chinese reactions to our fiscal instability.
Rahn, Senior Fellow at the Cato Institute & Chair of the Institute for Global Economic Growth, 2009 (Richard, The Growing Debt Bomb, http://www.cato.org/pub_display.php?pub_id=1056 From Damien

The entitlement programs (i.e., Social Security, Medicare, Medicaid, etc.) all continue to grow faster than the economy, and they will take more than 100 percent of all federal tax revenue this year, requiring that virtually all of the other government spending programs, including defense and interest payments on the debt, be funded by more borrowingThe best that any tax increase could do is delay the explosion of the debt bomb by, perhaps, a couple of years while further weakening the economy and job growth. Now suppose you are not an individual bondholder but the Chinese government official responsible for the Chinese economy, and you know your government holds about $1 trillion in U.S. government securities. You have watched Congress and the administration become less and less fiscally responsible more spending, more taxes, and more debt. The Chinese are not stupid, and they have been vocal in saying they are concerned that U.S. policies will lead to a further fall in the dollar and higher rates of inflation, both of which undermine the value of their investment in U.S. government securities. When the debt bomb explodes within the next one to three years expect to see record high real interest rates and/or inflation, coupled with a collapse of many "entitlements." It will be like the neutron bomb, the buildings will be left standing, but the people will not. The entitlement spending may consume all of our governmental expenditures, leaving our military hollow and precipitating global wars. Zalmay Khalilzad 2011 [February 8, The Economy and National Security http://www.nationalreview.com/articles/259024/economy-and-national-security-zalmaykhalilzad If we dont get our economic house in order, we risk a new era of multi-polarity. Today, economic and fiscal trends pose the most severe long-term threat to the United States position as global leader. While the United States suffers from fiscal imbalances and low economic growth, the economies of rival powers are developing rapidly. The continuation of these two trends could lead to a shift from American primacy toward a multi-polar global system, leading in

turn to increased geopolitical rivalry and even war among the great powers. The current recession is the result of a deep financial crisis, not a mere fluctuation in the business cycle. Recovery is likely to be protracted. The crisis was preceded by the buildup over two decades of enormous amounts of debt throughout the U.S. economy ultimately totaling almost 350 percent of GDP Without faster economic growth and actions to reduce deficits, publicly held national debt is projected to reach dangerous proportions. If interest rates were to rise significantly, annual interest payments which already are larger than the defense budget would crowd out other spending or require substantial tax increases that would undercut economic growth. Even worse, if unanticipated events trigger what economists call a sudden stop in credit markets for U.S. debt, the United States would be unable to roll over its outstanding obligations, precipitating a sovereign-debt crisis that would almost certainly compel a radical retrenchment of the United States internationally. Such scenarios would reshape the international order. . The closing of the gap between the United States and its rivals could intensify geopolitical competition among major powers, increase incentives for local powers to play major powers against one another, and undercut our will to preclude or respond to international crises because of the higher risk of escalation. The stakes are high. In modern history, the longest period of peace among the great powers has been the era of U.S. leadership. By contrast, multi-polar systems have been unstable, with their competitive dynamics resulting in frequent crises and major wars among the great powers. Failures of multi-polar international systems produced both world wars.

Potential Plans: Privatization Many authors, particularly at libertarian think tanks, have long argued that Medicare and Social Security, as government run programs, displaced more efficient and effective private markets. That retirement accounts or health savings accounts provided by private lenders gave individuals more choice about how much they wished to save and spend, and caused users to become more informed consumers, which would address the root causes of health care inflation. As exemplified by the Ryan proposal, many advocate allowing individuals to Opt Out of Medicare or Social Security that they would no longer have those taxes removed from their payrolls and using tax credits to encourage workers to invest in individual retirement accounts or health savings accounts. Alternatively, instead of receiving Social Security or Medicare benefits, seniors could choose to invest their benefits in the form of a voucher in private accounts. For Social Security, global empirical examples are often held up as proof that privatizing Social Security will work. Daniel Mitchell, 2011 [http://www.cato-at-liberty.org/the-case-for-social-security-personalaccounts/The Case for Social Security Personal Accounts Other nations have figured out the right approach. Australia began to implement personal accounts back in the mid-1980s, and the results have been remarkable. The governments finances are stronger. National saving has increased. Another great example is Chile, which set up personal accounts in the early 1980s. . All told, about 30 nations around the world have set up some form of personal accounts. Even Sweden, which the left usually wants to mimic, has partially privatized its Social Security system. It also should be noted that personal accounts would be good for growth and competitiveness. Reforming a tax-and-transfer entitlement scheme into a system of private savings will boost jobs by lowering the marginal tax rate on work. Personal accounts also will boost private savings. And Social Security reform will reduce the long-run burden of government spending, something that is desperately needed if we want to avoid the kind of fiscal crisis that is afflicting European welfare states such as Greece. For Medicare, that money would be invested in a Health Savings Account. Money is drawn out of the savings account to pay for medical procedures, giving the consumer an incentive to find the least expensive care, and to forgo unnecessary care. This addresses the root cause of Medicare collapse high health care costs. Shikha Dalmia, senior analyst with the Reason Foundation 2007 [Should Medicare be MeansTested? A Symposium is a nonpartisan, tax-exempt, public policy and educational institution MAY http://www.american experiment.org/uploaded/ files/should _medicare_be_meanstested.pdf The second possibility is a consumer-driven system in which employers and government, instead of purchasing health insurance for employees or Medicare beneficiaries, give people a fixed amount to spend on their health care needs. Indeed, putting consumers in charge of their own health care dollars is a far better way of putting Medicare on a sound fiscal footing than meanstesting the program. For starters, Medicare Part A, which covers hospitalization bills of all seniors, is already means-tested, given that seniors with higher incomes pay higher payroll taxes. Meanstesting Part B, the optional plan that covers doctors bills and outpatient diagnostic procedures, makes sense at first blush, given that seniors contributions cover only 25 percent of its cost, and federal general revenues pick up the rest of the tab. Yet asking wealthier seniors, who also tend to be healthier, to pay more will drive them out of the program, raising premiums for those

remaining. Far better would be to give the $300 billion or so the federal government spends on Medicare directly to seniors so they could combine it with their out-of-pocket expenses and buy health insurance as they see fit. Consumer-driven reforms might mean that seniors will have to shop around and think before consuming medical services, just as they do before buying groceries or clothes or other essentials. But self-rationing of health care is far better than rationing by queue or by bureaucratic fiat. Raising the Age Requirement: One way to reduce spending on Social Security or Medicare would be to reduce the number of people who qualify for the benefits. Currently, the FRA (Federal Retirement Age) is 65. Seniors born before 1960 qualify for Social Security at that age, and for those born after, they are eligible at 67. Raising that age would substantially reduce the spending for those programs and can head off the financial crisis David Henderson, former economist with Reagan's Council of Economic Advisers, 2010 [FEBRUARY 17, Raise the Age ttp://econlog.econlib.org/archives/2010/02/raise_the_age.html# Many people agree that the age limit should be raised, given that life expectancies are higher than when Medicare was implemented in the mid-1960s and given that people in their late 60s are, on average, healthier than their counterparts of 40 years ago. But many of these same people despair that it could ever be done. Yet we have a case where just something like that was done: the Social Security reforms of 1983 one Democratic Congressman, Jake Pickle from Texas, bravely added an amendment and got it through. That amendment raised the Social Security age, in steps and in prospect, from 65 to 67. No one could argue that he wouldn't have time to plan because the increase was gradual enough to let people plan. The same thing could be done with Medicare: raise the age to 67 in steps by, say, 2018 (three months per year for every year between now and then), and then index both the Social Security age and the Medicare age to life expectancy. This is a good bit faster than for Jake Pickle's reform, but the problem is also more serious. I don't like making these proposals because, as I wrote above, I think the whole system should be abolished. But it is a significant step toward solving a financial tsunami before it hits. A different change to the age requirement would be to index it to life expectancy, which allows a little bit more flexibility for change in the future. Jagadeesh Gokhale, November 11, 2010 [Indexing SS NRA to Lifespan: Commentary on the Obama Debt Commission's Social Security Reform Proposals http://www.cato.org/pub_display.php?pub_id=12551 5) Index retirement ages to life expectancy: This is a long overdue reform. Social Security's retirement ages have remained relatively fixed whereas post-retirement lifespans have increase substantially. This has transformed Social Security from an erstwhile retirement insurance system to a retirement saving system, one that essentially substitutes government saving for private saving. But the reform does not go far enough. The proposal allows the current rate of increase in the normal retirement age to remain in place until NRA reaches age 67 for those born in 1960 (who will attain age 62 in 2022). Instead, the current rate of increase in NRA should have been accelerated and extended until the normal retirement age reached age 72 sometime by the mid 2030s. Given the considerably healthier and more active population of middle-aged and elderly today, this alternative policy would have made up for the long delay in increasing working lifespans and restoring the program to its original function of providing old-age insurance.

Changing the age requirement is consistent with the goal of privatization any system of vouchers for private accounts would make the age of retirement irrelevant, and eliminate an artificial incentive to retire early. Jagadeesh Gokhale, November 11, 2010 [Indexing SS NRA to Lifespan: Commentary on the Obama Debt Commission's Social Security Reform Proposals http://www.cato.org/pub_display.php?pub_id=12551 However, even better would be a complete elimination of early and normal retirement ages by introducing a personal accounts system wherein the responsibility for determining one's desired retirement living standard and generating the corresponding savings beyond a minimum traditional Social Security benefit would reside with individual workers. The reason for this is that statutory retirement ages together with retirement incentives prompt economically and socially inefficient (default-driven) early retirement decisions on the one hand, and deny adequate pay-back from Social Security to those with shorter expected lifespans. If the Affirmative wishes to phase out Medicare, and age based test for benefits would smooth a transition to a post Medicare program. John Graham, director of Health Care Studies for the Pacific Research Institute 2007[Should Medicare be Means-Tested? A Symposium is a nonpartisan, tax-exempt, public policy and educational institution MAY http://www.americanexperiment. org/uploaded/ files/should _medicare_be_meanstested.pdf Age-Testing is More Important than Means-Testing Although higher earners contribute disproportionately to the trust fund, funding it by payroll tax rather than income tax creates some flattening of the otherwise harmful progressive income tax, which should itself be flat. This provides another challenge to meanstesting, because it would eliminate this valuable (if slight) effect and effectively increase the punitive taxation of high earners. Further, meanstesting likely worsens the malformation of private health insurance market, because the real purpose of Medicare is not to provide health care. Indeed, the introduction of Medicare did not improve seniors mortality. What it did was reduce the risk of catastrophic out-of-pocket costs for the very small number of seniors who have huge health care costs in any year. In 1963, just before Medicare was introduced, even Americans aged 65 to 74, with health care expenses in the 75th percentile, spent an average of only $363 in out of pocket on health care expenses (in 2007 dollars). However, the top one percent spent $6,682 per person. Finally, if the government did try to impose general Medicare means-testing on high-earning seniors, rich seniors would likely figure out ways around it. After all, wealthy seniors successfully game Medicaid to finance their long-term care through asset transfersa fact known for years but only recently, and marginally, addressed by last years Deficit Reduction Act. But unlike income, age cannot be hidden. Age-testing is more likely to succeed in solving this mess, although it would take a lot of groundwork to gain public acceptance. Basically, the government would tell people over 55 that their Medicare expectations are unchanged, while telling those under 30, for example, to forget about receiving any benefits. People aged between those bounds would be assigned a constant, derived from a simple linear function, which would stay with them for life and would be applied to their benefits. For example, a 50-yearold would expect 80 percent of the full benefits, and 40-year-old, 40 percent. Then we would freeze the actuarially determined benefits and issue bonds to fund them, similar to what President Bush proposed for Social Security reform. This would cause Medicare to die a slow but predictable death, while responsibly addressing the fact that the United States is the only country (to my knowledge) where the government orders you out of whatever health insurance you have and into a government program at age 65. That is why both private insurers and individuals face inadequate incentives to negotiate insurance policies that provide cradle to grave coverage with the optimal incentives for preventive versus curative

care. Reforming Medicare by introducing age-testing would both save the nations fiscal house from burning down and gradually improve the incentives for private insurance, something that means-testing, even if politically feasible, would not achieve. Reducing Benefits Rather than changing Who receives benefits, another set of affirmatives would change the benefits that each person receives. While the calculations for each person are extremely complicated, and no one size fits all for a reform, changing the way benefits are calculated to adjust for inflation would provide a substantial reduction in costs Michael Tanner, Cato Institute, 2011 [Many different plans Bankrupt Entitlements and the Federal Budget No. 673 March 28, 2011 http://www.cato.org/pubs/pas/pa673.pdf Of course there are many different ways to reduce future Social Security payments with very different impacts on recipients. The bipartisan Commission on Fiscal Responsibility and Reform, for instance, has recommended a broad array of benefit changes, including raising the retirement age to 69 by 2075, with the early retirement age rising to 64 over the same period, reforming the formula for annual cost of living adjustments (COLAs), and trimming benefits for high-income recipients.86 A better approach would be to change the formula used to calculate the accrual of benefits so that they are indexed to price inflation rather than national wage growth.87 Since wages tend to grow at a rate roughly one percentage point faster than prices, such a change would hold future Social Security benefits constant in real terms, but eliminate the benefit escalation that is built into the current formula. Estimates suggest that making this change alone would result in a 35 percent reduction in Social Securitys currently scheduled level of benefits, bringing the system into balance by 2050.88 Variations on this approach would apply the formula change only to higher-income seniors, preserving the current wage-indexed formula for low-income seniors.89 Other benefit reductions that have been discussed at one time or another include increasing the number of years included in income averaging as part of the benefit formula from 35 to 38 years, restructuring spousal benefits, and various means/asset-testing schemes.90 Means Testing Another way of changing who is eligible for Social Security or Medicare is to means test recipients. All persons who have paid into the system are currently eligible, including those with the means to provide for themselves through private retirement accounts and health insurance. Other federal social welfare programs, like Medicaid and TANF, are means tested to direct the benefits to those who need them the most those without the financial means to protect themselves. Tyler Cowen, 2008 [New York Times Economic View: Means Testing, for Medicare July 20, http://www.nytimes.com/2008/07/20/business/economy/20view.html An alternative path is to put in place more means testing throughout Medicare. For instance, higher-income older Americans have already been paying larger Medicare premiums and receiving a lower prescription drug benefit; thats part of what made it possible to expand the prescription benefit within budgetary constraints The best option is probably to tie the size of Medicare benefits to a persons lifetime income, which is relatively easily measured and hard to game, rather than to ones income or assets in any current year. In essence, higher earners would receive lower benefits instead of facing the prospect of higher taxes, as current trends predict. Requiring Larger Premiums

Medicare Part B requires seniors to pay premiums for gap coverage for physician services. The premiums that they pay cover some of the costs of the program, with the government making up the rest of the shortfall. Increasing the amount that seniors would pay would reduce the governments spending. Alice Rivlin, 2011 Brookings Institute [Making Medicare, Medicaid and Social Security Sustainable for the Long Run http://www.brookings.edu/testimony/2011/ 0317_house_budget_rivlin.aspx The Affordable Care Act includes important provisions aimed at improving health outcomes and reducing cost growth: authorizing Medicare to contract with accountable care organizations on the basis of shared savings and value-based payments to providers; pilot projects to try out other payment reforms; research on effectiveness of treatments; and development of information technology. However, the impact and timing of these efforts is still uncertain. Therefore, the Task Force recommended several cost-saving reforms in the short run followed by a gradual transition of Medicare to a "premium support" or defined contribution program, which would incent efficient delivery while controlling the rate of growth of total Medicare costs. For the short-term, the Task Force proposed these measures: Gradually raise Medicare Part B premiums from 25 to 35 percent of total program costs (over five years); Use Medicare's buying power to increase rebates from pharmaceutical companies Administrative Costs An affirmative may attempt to decrease spending by addressing fraud and waste in Medicare and Social Security. This would have the advantage of streamlining the system, and not reducing benefits to seniors. Medical Rationing Instead of reducing the number of people who receive benefits, or the overall amount that people receive, some affirmatives may choose to reduce Medicare spending by restricting the type of medical procedures that qualify for reimbursement. Managed care systems and rationing of care would help to reduce costs. Banning Medicare or Social Security Some Affirmatives, particularly Really Libertarian or Kritikal teams, may choose to simply phase out Medicare and/or Social Security, and claim that market alternatives will solve better without government interference.

4. Negative Ground:
Case: There is substantial debate about whether Social Security and Medicare are financially stable or not. While there seem to be shortfalls, a substantial number of authors conclude that the programs are healthy and stable in the long term, and that cuts now will only hurt the recipients of benefits. Mark Weisbrot, of the Center for Economic and Policy Research, is one of the leading advocates of this position. He claims that the Phony Crisis is being used to push a privatization political agenda: There is a widespread belief among almost all sectors of society that Social Security is headed for serious financial troubles, and is in need of a major overhaul. The persistence of this particular belief provides one of the most compelling examples of how politics, powerful interest groups, and pervasive intellectual sloppiness on the part of those who inform the public can, in some cases, cause policy debates to take place under completely false premises.. Social Security is the nations largest anti-poverty program, with its payments keeping about half the nations elderly above the poverty line.. Medicare is also falsely portrayed as facing grave demographic threats to its solvency, and is currently threatened by attempts at further privatization. The myth of a demographic time bomb has also served to shift the focus of health care reform to Medicare (the public sector), whereas the private sector has been the source of our most important problems At the same time, the myths surrounding Social Security make it difficult to apply the most valuable lessons from Americas most successful social insurance program to the problem of health care reform where they are badly needed. The CEPR has taken the lead in compiling publications and studies to debunk the Phony Crisis. They claim that demands for privatization come from deficit hawks that spread fear and claim that decreasing the deficit must be the countrys number one priority. This is used to avoid solutions to the true cause of Social Security and Medicare problems unemployment and a lack of universal health coverage. Focus should be on reforming and restructuring the financial sector, not on cutting these popular and effective programs. If the focus is on cutting back or removing government programs and not on reforming health care, spending may decrease but more middle class families will be unable to afford health care. Robert D Feinman looks at the rhetoric surrounding the Social Security and Medicare debates and says that most Affirmative authors are crying wolf over Medicare/Medicaid instead. This is mostly unwarranted. [http://robertdfeinman.com/society/medicare.html 2005 The Phony Medicare Crisis] No lesser economic mind than Paul Krugman also believes that the Fiscal Crisis mentality for Medicare and Social Security is overblown. He writes that the deficits of the programs are only on paper, and that there is no serious funding crisis: it seems important to debunk the hype about a Social Security crisis. There's nothing strange or mysterious about how Social Security works: it's just a government program supported by a dedicated tax on payroll earnings, . Right now the revenues from the payroll tax exceed the amount paid out in benefits. This is deliberate, the result of a payroll tax increase recommended by none other than Alan Greenspan two decades ago. The grain of truth in claims of a Social Security crisis is that this tax increase wasn't quite big enough. Projections in a recent report by the Congressional Budget Office say that the trust fund will run out in 2052. The system won't become "bankrupt" at that point; even after the trust fund is gone, Social Security revenues will cover 81 percent of the promised benefits. Still, there is a long-run financing problem. But it's a problem of modest size. The report finds that extending the life of the trust fund into the 22nd century, with no change in benefits, would require additional revenues equal to only 0.54 percent

of GDP. [The San Diego Union-Tribune The phony crisis of Social Security December 9, 2004 http://www.signonsandiego.com/uniontrib/20041209/news_lz1e9krugman.html There is also a significant amount of solvency evidence going against the reforms mentioned in the affirmative proposal section. It is beyond the scope of this paper to answer the solvency for each case I think that it is sufficient to say that there is a substantial literature base both ways on solvency for each plan. Disadvantages: The two disadvantages that make up the core literature on the resolution are the economic impacts to cutting Social Security and Medicare, and the political reaction to it. The economic arguments revolve around undermining the safety net for millions of American retirees, the impact that this would have on the confidence of elderly consumers, and on the impact this would have on employment practices. However, the primary Real World reason that the programs are not being reduced is the political backlash that it would spark. Some of the most politically powerful lobbying groups in the US are made up of Senior Citizens. They strongly support Medicare and Social Security, and would react vehemently to any attempts to reduce spending. Past attempts to reform or privatize the programs have been met with substantial resistance, such that the reforms were abandoned. While some political leaders are now breaking the taboo by offering reforms, this does not mean that they will not be controversial. During an election year, the ability to run Medicare and Social Security links would encourage most politics debaters. Counterplans: I think that the strongest strategies by the negative would revolve around counterplans that challenge the fundamental political and economic ideologies of the affirmative. Many of them are discussed as competitive options within the literature, providing excellent competition debates. Many of them are mutually exclusive approaches to reform, focusing the debate on solvency and encouraging Depth to this debate. I think that the closest parallel is the Health Care topic, where different affirmatives were competitive options with each other, and became common Counterplan strategies. The first counterplan would focus on employment and growth. One of the initial criticisms in the Phony Crisis positions is that the Social Security alarmists underestimate the levels of growth in the economy over the next 30-40 years. As employment rises and growth speeds up, more revenues are brought in through payroll taxes. While this increases the committed benefits, it also provides the capital to shore up trust funds and to pay off Treasury Securities until after the demographic shift peaks. The Deficit hawks are more concerned about lowering growth to head off inflation, which necessitates reducing spending. A counterplan that used fiscal stimulus to increase employment, training and long term growth prospects challenges all of the fundamental assumptions of the case. Another set of counterplans would increase revenue, rather than decrease spending. Increasing the premiums that are charged for Medicare B coverage, increasing the rate of payroll taxes, or increasing the infusion of General Federal Revenues into the programs would head off system collapse, while avoiding the political fallout from cutting benefits. Another type of counterplan would look to reform Medicare or Social Security without substantially cutting spending. Addressing fraud, waste, administrative costs, or adopting a Panel Approach to reform would potentially put off the day of reckoning for the programs.

5. Topic Criteria:
Timeliness: Politically, entitlement reform is one of the most timely issues. It is on the front burner of the Republican agenda, is tied to the Debt Ceiling debate over the summer, and will be integral to the 2012-2013 budget negotiations. Medicare reform legislation has been introduced in Congress, and the debate over it is likely to produce up to date arguments and information Scope: Debates about entitlement reform squarely represent the political divide in the nation, reflecting different views of the responsibilities of government. This political divide is represented across the entire nation. Range: Social Security and Medicare reforms are good topics for both Novices and Varsity debaters. The basic positions can be accessible to novices and lay judges, while the depth of specific competing proposals would challenge varsity debaters. Quality: An entitlement reform topic would produce quality debates because the primary sources of clash would be over solvency mechanisms, rather than harms. Those solvency mechanisms compete in the literature, providing depth to the research in those debates. Material: Medicare and Social Security have enormous amounts of research dedicated to them. Most policy related think tanks have entire Research Areas dedicated to entitlements, there are annual government reports on the programs finances, and pending legislation has unleashed a flood of interest in the media. It may be difficult to conceive of a topic with more accessible research materials. Interest: At first glance, debaters may be deterred by the economic nature of the topic (Actuarial reports make for Dense reading. I am speaking from experience), and the topic area retirement security might not appeal to many debaters. I think that once researched, this becomes a Very interesting topic; I think debaters would be satisfied with the advantage areas and not try to avoid clash, and advanced debaters would be interested in detailed solvency debates. I think that this would be much more like the Health Care topic, and less like the Poverty, Juvenile Crime or Retirement Security topics. Balance: Three things contribute to the balanced nature of an entitlements topic. First, Evidence the literature base for Social Security and Medicare is strong on both sides of the topic. Second, Predictability the topic provides a Mechanism with a Direction reducing spending on entitlements. Third Fair and Balanced - it is a Conservative topic. Most of the resolutions are written with a Liberal direction. This one is not. I do not know if that is Balance but it seems to be fair.

6. Why this topic:

In my limited experience writing topic papers, I am beginning to formulate a basis for what I think constitutes a Good topic. I start with an initial question: Are the core cases on the topic area ones that Affirmatives will embrace, or will they try to circumvent the topic, racing to the fringes to debate about something that they would prefer to debate about. I think that entitlement spending would capture the interest of Affirmatives, both because of the size and quality of the advantage areas, and because of the depth of the literature on the core cases. I think that it is more important to choose an issue that Affirmatives will embrace, rather than attempting to craft a topic wording that constrains them. I also think that it is important to debate taboo political subjects. I do not mean that we should have topics of fringe conspiracy theories, but rather that if an important public issue is going to impact our nation in more ways than virtually any other issue, but Public Debate is Avoided or Absent on that topic, that is regressive rather than progressive. The fact that Social Security has been the Third Rail is a reason we Should debate the topic, rather than avoid it. I then ask whether the core cases have mechanisms in their plans that are reflected in the literature, and whether they go in a specific direction. I think that the entitlements topic has a simple wording that reflects a core direction, and can use verbs like reduce spending or limit growth of spending that are both directional and possible to be met directly in the plan. Then I try to think about how to prevent the devolution of Negative strategies intended to skirt the topic. With domestic topics, this means How to you avoid every round becoming a States CP / Politics debate? Well, the entitlements topic manages to avoid States rather well, by reducing Federal spending (something states cannot fiat), but does not avoid the Politics debate. In fact, it is hard to think of a topic that would rely More heavily on the Politics disad. Which leads me to two thoughts: First while the links are very good, they are very good in Both directions. And for reasons that are detailed and linked to specific proposals. They also reflect an important, fundamental political divide, which means the Affirmative plan may very well impact the overall agenda, unlike most years where the internal links are far-fetched. Second there is the possibility to transform the Politics disad. Normally, I view the Politics disad as an example of everything that is bad about debate. But that doesnt mean that it has to be. A real world quid pro quo exists between Medicare reform and the Debt Ceiling debate, and the coming Budget battle. The compromises and trades are very explicit and debatable. And the quality of the link evidence may encourage debaters to engage at that level, rather than focusing on Impact Scenarios, Uniqueness Walls, Terminal Impact Defense, and all of the other pitfalls of the Politics disad.

7. Potential Resolutions:
1. Resolved: the United States federal government should substantially reduce its Medicare and/or Social Security spending 2. Resolved: the United States federal government should substantially reduce its spending for Medicare and/or Social Security. 3. Resolved: the United States federal government should substantially limit the growth of Medicare and/or Social Security spending. 4. Resolved: the United States federal government should substantially reduce Medicare and/or Social Security benefits. 5. Resolved: the United States federal government should reform Medicare and/or Social Security to ensure program sustainability. 6. Resolved: the United States federal government should substantially limit the growth of entitlement spending.

8. Wording Issues:
Privatization: I strongly think that one of the most important core affirmative plans is privatization; either through MIRAs, MSAs, HSAs, vouchers or premium plans. This is the central thrust of the Ryan proposal, and it is an important part of the Cato Institute, Heritage Foundation, Social Security Institute, and Peter G. Peterson Institute proposals for reform, which make up an important part of the literature. Therefore, I think that the topic should be written in such a way that it encourages this Affirmative plan, because excluding it would distort what many authors are advocating. However, reduce spending, reduce benefits, or limit the growth of spending all seem to exclude this case. The plan could cut Medicare spending without requiring that the remainder is given in the form of a voucher. Therefore, any privatization mandate or option would be arguably extra topical. And many proposals do require Both of the mandates cuts in Medicare would only provide adequate coverage if the remaining benefits are spent more efficiently, which vouchers would encourage by increasing patient choice (arguably). So forcing the Affirmative to only do the first part would hurt their ability to access their solvency evidence, which is at the core of the literature. One solution would be to use the term reform Medicare and/or Social Security to ensure fiscal sustainability. Clearly, the package of cuts with vouchers both fall under the term reform. I am loathe to do this, however. Reform is a virtually meaningless term. Websters Defines it as Reform: a : to put or change into an improved form or condition b : to amend or improve by change of form or removal of faults or abuses . There are a lot of Google hits for reform Medicare (600,000) or Social Security reform (1,000,000), but none of them are definitions (Im assuming here I obviously did not read each one), and none of them would Exclude other reforms. Reform would eliminate one of the strengths of the resolution the direct action that is mandated for the plan to include, which is pretty essential to predictably negative ground. If we used the phrases The USFG should establish a reform to reduce Medicare spending or the USFG should reform Medicare to ensure fiscal sustainability you introduce an Outcome into the resolution something that the federal government cannot Fiat. The plan cannot Mandate sustainability, it can only Result in sustainability. If reform just means to change or improve, then the only thing that the affirmative need to do be topical is have an advantage. This both introduces a mandatory Effects debate into Every affirmative, but it also significantly unlimits the number and type of case the affirmative can run. I am convinced that people would still run privatization, and that judges would still accept it, so I am not tremendously concerned about the Extra Topicality problem. First, there is ample precedent for this: DADT was simply exempted into the National Service topic, Pharmaceuticals were allowed on the Africa topic, and Futenma was accepted as topical on the Military Presence topic. While none of those probably met any reasonable definition of those resolutions, they were obviously reasonably core cases, and simply allowed. Second, there is a Lot of contextual evidence saying that the Ryan proposal reduces Medicare spending. Think Progress, for the negative, says while Paul Ryans plan to eliminate Medicare will reduce Medicare spending, it simply shifts those costs onto patients. [Yglesias, May 25, 2011] The Association of American Medical Colleges on the Affirmative, says the Ryan proposal would reduce Medicare spending by $30 billion over 10 years. Much of the savings would be achieved by privatizing Medicare for future The GOP plan would reduce Medicaid spending by $771 billion over 10 years. [April 8, 2011] Entitlement vs Medicare and/or Social Security: The common label given to both Medicare and Social Security spending is Entitlement spending. A substantial amount of literature refers to it that way, and a number of think tanks use Entitlement as their category heading. Legislation on Medicare and Social Security both define Entitlement, and provide their programs as examples of it. Entitlement spending is a term of art that is well represented in the literature. Using

the term entitlement spending is simpler and more elegant, and provides additional room for creative affirmatives to move beyond Social Security and Medicare. So why specify the programs in the resolution? Why not just say substantially reduce entitlement spending.? My strong preference is to specify Medicare and Social Security. Several reasons: First, the definitions of Entitlement spending are not strictly limited. Medicaid and Veterans Benefits certainly are also entitlements, and unemployment benefits are debatably entitlements. Many conservative commentators use the term to refer to discretionary programs that have a welfare component, like Food Stamps, that are probably Not entitlements, strictly speaking, but would have substantial contextual literature. This can be a good thing for creative affirmatives, but also messy. There are a substantial number of core cases on Medicare and Social Security, and I do not know the value of additional cases. Second Some of the additional entitlements would provide good cases like unemployment benefits or Medicaid cuts but some of them, like Veterans Benefits, would just be added on, like Kuwait was with the military presence topic. (Litmus Test I was not able to find a good affirmative solvency advocate for cutting Veterans Benefits substantially.) I think that if cases are added to the topic, it should be because they represent good, debatable ground. Paul Johnson explains the breadth that is potentially included The most important examples of entitlement programs at the federal level in the United States would include Social Security, Medicare, and Medicaid, most Veterans' Administration programs, federal employee and military retirement plans, unemployment compensation, food stamps, and agricultural price support programs. [A Glossary of Political Economy Terms 2005 http://www.auburn.edu/~johnspm/gloss/entitlement_program] I also think that including Agricultural Subsidies diverts the topic into very different areas. Third the focus of the affirmative ground with Medicare and Social Security is the long term fiscal stability of the programs, and their attendant impact on the federal budget. While Medicaid also faces fiscal issues, I would imagine that most of the cases for Medicaid would be about cutting a specific type of medical procedure or a specific group out of eligibility. And the other entitlement programs have nowhere near the same fiscal impact. Including other entitlement programs would expand the range of potential affirmative advantage areas, but that expansion would be toward tangential, unrelated advantages and away from the predictability of the core fiscal issues. Fourth the term Entitlement is often used as a pejorative. Conservative commentators often use the term loosely to refer to the welfare state, rather than in a strict sense as a description of a type of policy and benefit. I am not sure that adding that term would improve the kritikal debate so much as make it resolutionally focused rather than on the specific affirmative. And burdening the Affirmative with defending loaded terms seems to be a recipe for encouraging the Negative to skirt core issues. Funding vs Spending vs Expenditures I initially thought that this would be a rout for spending but actually, all three terms are fairly well represented within the literature, and many articles use both or all terms interchangeably. I do not think that choosing one over the other would substantially impact the types of cases run or the types of negative strategies. Spending vs Benefits Reduce Medicare Benefits would limit the topic significantly more than reduce Medicare spending and would be more precise and predictably. There is a significant amount of literature on reduce benefits (well over 5,000,000 combined hits) and there is a substantial amount of quality solvency

advocates, as many authors advocate reducing the size of benefits. I think that ultimately, this may be Too limited it is Overly predictable, and gives the affirmative too few mechanisms. The cases that it would exclude would be ones that reduce fraud or waste, ones that change age limits or means test, ones that ration medical procedures, and ones that shift to privatization. It is a subjective call, to balance predictability with adequate affirmative choices, but I think that some important cases would be excluded and for an insubstantial benefit. Reduce spending vs Limit the growth of spending I am not sure that this would significantly change the types of cases that are run, because most authors who advocate spending cuts do so to with the implicit idea of limiting the growth of spending. I guess that the only difference would be that limit the growth would allow the affirmative to prevent future increases, rather than decrease it from current levels. I dont know the strategic benefit of that, and unfortunately, the literature seem to use the terms interchangeably. I understand the technical distinction in the types of cases allowed, and the theoretical advantages to we keep the status quo but I do not think that practically, it would have that much impact on what is run by the affirmative. Substantially A lack of definitions, but a lot of literature. There is a significant amount of literature using the phrases substantially reduce Medicare and substantially reduce Social Security about 7,000 Google hits each. Most of these are cards about whether specific proposals will substantially reduce costs, rather than definitions of how much of a reduction would be necessary in order for it to be substantial. A Democratic proposal to save about $100 billion by altering the procedures for purchasing pharmaceuticals was called substantial: This bill shows there are ways to substantially reduce Medicare costs without hurting beneficiaries," said Rep. Levin [Jun 17, 2011 Congressional Documents Press Release] While $100 billion sounds like a lot, compared to a $37 trillion shortfall, it is a relatively small percentage of Medicare spending. Another proposal to stop postponing a cut in fees for doctors who receive Medicare (which is required by a law passed in 1997, but has been postponed every year since then): would cut Medicares costs very substantially over current policy The virtue of this approach is that no one has to do anything the sustainable growth rate is already in law. All our leaders have to do is promise not to change the law and instead allow it to take effect on schedule. [Bruce Bartlett, May 17, 2011, The Real Social Security and Medicare Problem] Another proposal, to means test Medicare recipients: Means-testing Part B premiums is expected to reduce Medicare spending by approximately $13 billion over a 10 year period. This will not substantially alleviate the program's financial problems. Means-testing will not substantially reduce Medicare spending. [Gerard Anderson, 2007 Means-testing in Medicare] Another proposal to reduce adjustments to benefits based on inflation: The COLA [Cost of Living] cut would both substantially reduce Social Securitys 75-year deficit. Increasing the FRA [Federal Retirement Age] to 68 would have a much smaller impact [Urban Institute, 2010 Distributional Effects of Alternative Social Security Reforms] Finally, referring to a proposal from 2005 by Paul Ryan to privatize Social Security: Finally, even the smaller accounts adopted for the first 10 years would substantially reduce Social Security's long-term deficits [ Lawrence A. Hunter, May 12, 2005 Start the Accounts]

9. Definitions:

Entitlement Spending ........................................................................................................................................... 24 Entitlement Program ............................................................................................................................................ 25 Entitlements.......................................................................................................................................................... 27 Entitlement Authority........................................................................................................................................... 28 Mandatory Spending ............................................................................................................................................ 29 Direct Spending .................................................................................................................................................... 30 Discretionary Spending ......................................................................................................................................... 31 Welfare Spending.................................................................................................................................................. 33 Social Welfare Expenditures ................................................................................................................................. 34 Emergency Spending ............................................................................................................................................ 35 Medicare ............................................................................................................................................................... 36 Social Security ....................................................................................................................................................... 39 Reform ................................................................................................................................................................... 41 Medicare Reform .................................................................................................................................................. 42 Social Security Reform.......................................................................................................................................... 43

Entitlement Spending
Entitlement Spending The People Decide Glossary, 2008 http://www.thepeopledecide.us/glossary_definition_detail.php?gid=190 Glossary Term : Entitlement Spending: ENTITLEMENT SPENDING refers to funds for programs like Medicare/Medicaid, Social Security, & veterans' benefits. Funding levels are automatically set by the number of eligible recipients, not at the discretion of Congress. Each person eligible for benefits by law receives them unless Congress changes the eligibility criteria. Entitlement payments represent the largest portion of the federal budget. Entitlement Spending C-SPAN Congressional Glossary 2004 http://legacy.c-span.org/guide/congress/glossary/entitle.htm ENTITLEMENT SPENDING refers to funds for programs like Medicare/Medicaid, Social Security, & veterans' benefits. Funding levels are automatically set by the number of eligible recipients, not at the discretion of Congress. Each person eligible for benefits by law receives them unless Congress changes the eligibility criteria. Entitlement payments represent the largest portion of the federal budget. Entitlement Spending Edward A. Zelinsky is a professor of law at the Benjamin N. Cardozo School of Law of Yeshiva University 2002 - Ohio Northern University Law Review Restoring Politics to the Commerce Clause: The Case For Abandoning The Dormant Commerce Clause Prohibition on Discriminatory Taxation Insofar as Professor Coenen's arguments track Professor Enrich's and the teachings of the tax expenditure school, the replies are also the same. Tax incentives and direct subsidies need not (and often do not) take the idealized forms central to tax expenditure analysis. Tax incentives can be and are structured to be of limited duration, thus requiring legislative renewal and review on expiration. Direct spending in entitlement form is "presumptively permanent" and thus beyond routine legislative scrutiny. In practice, most tax and spending policies are accepted as part of a baseline status quo which the legislature adjusts incrementally at the margins rather than reviews from scratch. Entitlement Spending Michael J. Graetz Professor of Law, Yale Law School. April, 1995 Columbia Law Review PAINT-BY-NUMBERS TAX LAWMAKING Routine congressional reliance on estimates of questionable reliability has been compounded by Congress' insistence on grounding parliamentary objections during consideration of legislation and, in some instances, even legal compliance with general budgetary requirements, on predictions of changes in revenues for each year of a five-year budget period. Beginning with the enactment in 1985 of the Gramm-Rudman-Hollings Budget Act, 150 estimates of the annual revenue effects of legislation directly triggered sequestration, a series of across-the-board spending cuts. This central role for revenue estimating continued through the 1987 Amendments of Gramm-Rudman 151 and was, if anything, enhanced by the so-called pay-go requirements of the 1990 Budget Act which linked sequesters of "entitlement" spending - spending on such things as Medicare, Medicaid, and farm price supports - to five-year estimates of the annual revenue effects of tax legislation. The amendments also required that any provisions that are estimated to lose revenue in any year of the budget period must be offset by revenue-gainers of a magnitude equal to the forecasted loss. 152 This basic mechanism of the 1990 Act remains in force, but the Senate has expanded the relevant period for revenue estimates from five to ten years in some circumstances. 153

Entitlement Program
Entitlement Programs Dr. Paul M. Johnson Department of Political Science Auburn University A Glossary of Political Economy 2005 http://www.auburn.edu/~johnspm/gloss/entitlement_program Entitlement program The kind of government program that provides individuals with personal financial benefits (or sometimes special government-provided goods or services) to which an indefinite (but usually rather large) number of potential beneficiaries have a legal right (enforceable in court, if necessary) whenever they meet eligibility conditions that are specified by the standing law that authorizes the program. The beneficiaries of entitlement programs are normally individual citizens or residents, but sometimes organizations such as business corporations, local governments, or even political parties may have similar special "entitlements" under certain programs. The most important examples of entitlement programs at the federal level in the United States would include Social Security, Medicare, and Medicaid, most Veterans' Administration programs, federal employee and military retirement plans, unemployment compensation, food stamps, and agricultural price support programs. Entitlement Programs Charles Konigsberg former Assistant Director of the Office of Budget Management, 2007 America's Priorities: How the U.S. Government Raises and Spends $3,000,000 ...Googlebooks pp 398-99 The Budget Acts definition may be understood as setting forth a three part test for defining programs as entitlements: 1. Specified Benefits: the Programs authorizing legislation specifies particular sums of money to be paid. 2. Specified beneficiaries: The payments are to be made to a class of persons or governments who meet specified eligibility requirements. 3. Federal government has a legal obligation to pay that is not subject to appropriations: The payment is not discretionary; that is, the legislation obligates the United States to make the specified payments to the eligible class, and the legal obligation to make the specified payments to the eligible class of recipients is not contingent on appropriations being enacted. Therefore, if insufficient appropriations are available, the government, in theory, may be sued for payment of the benefits. Not that although entitlements legally obligate the United States to make specified payments, funds must still be appropriated to cover those payments. Some entitlement programs, such as Social Security, are permanently appropriated and annually appropriated entitlements share the common characteristic that the cost of the program has been determined outside of the appropriations process through the establishment of a formula driven program. Although annually appropriated entitlements might appear to be subject to annual funding decisions of the appropriations committees, in reality they are not. Entitlement Programs Kimberly Amadeo President of WorldMoneyWatch.com http://useconomy.about.com/od/glossary/g/mandatory_spend.htm Mandatory Spending Definition: Expenditures that must go into the U.S. budget that are mandated by programs outside of the budgetary process. These include Social Security, Medicare, Medicaid as well as Income Support programs such as Food Stamps and Veterans Retirement programs. Also Known As: Direct Spending, Entitlement Programs Examples: Mandatory spending within the U.S. budget will increase over the next ten years thanks to Social Security expenditures for retiring Baby Boomers.

Entitlement Program Capital Net 2011 The sources for this glossary include the US Senate and the Congressional Deskbook. http://www.thecapitol.net/glossary/def.htm#Entitlement%20Program: Entitlement Program A federal program that guarantees a certain level of benefits to persons or other entities who meet requirements set by law, such as Social Security, farm price supports or unemployment benefits. It thus leaves no discretion with Congress on how much money to appropriate, and some entitlements carry permanent appropriations. Entitlement Program Office of Management and Budget Budget of the US Government, FY 2004 1/23/2003 http://www.gpoaccess.gov/usbudget/fy04/pdf/budget/glossary.pdf Entitlement An entitlement program is one in which the federal government is legally obligated to make payments or provide aid to any person who meets the legal criteria for eligibility. Examples include Social Security, Medicare, Medicaid, and Food Stamps. Entitlement Program Peter G Peterson Foundation Glossary November 08, 2010 http://www.pgpf.org/Special-Topics/glossary.aspx Entitlement Program: A program that makes payments or provide benefits to certain individuals or groups that meet eligibility requirements, as authorized by law. Spending for entitlement programs (such as Social Security and Medicare) is set by the programs statutory eligibility and payment rules. (See also Mandatory Spending.) Entitlement Programs Elizabeth Garrett Assistant Professor of Law, University of Chicago. January, 1999 - Cardozo Law Review Accountability and Restraint: The Federal Budget Process and the Line Item Veto Act n9. Most entitlement programs are essentially permanently appropriated; Congress enacts authority to spend money and the obligation to pay money arises without a periodic appropriation. Familiar entitlement programs are Medicaid, Medicare, and Social Security. Entitlement spending, which is also sometimes called mandatory spending, is a subset of direct spending. Direct spending is any spending pursuant to a binding legal obligation to pay, including, for example, interest on the national debt. Entitlement spending is by far the largest component of direct spending.

Entitlements
Entitlement Albany Herald April 20, 2011 [Congress definition of entitlement skewed http://www.albanyherald.com/opinion/ headlines/Congress_definition_of_entitlement_skewed_120255419.html Page Two wants to know when Congress is going to drop the shoe. They keep talking about entitlements, but Im not sure what all should be considered entitlements. I have paid into SS for over 50 years and I consider it mine, not an entitlement. Congress is looking at raising the age of retirement to help cover their tracks of stealing SS and spending it for their own pay raises, as well as giving to welfare recipients, which I consider entitlement. If Congress can ease the retirement age up to the expected life span, then it can effectively raise taxes by the amount that is paid into SS. Entitlements Investors Glossary 2004 http://www.investorglossary.com/entitlements.htm Entitlements are government benefits provided by law to eligible individuals. Entitlements are typically for citizens only. In the US, major entitlements include the Medicaid, Medicare, and Social Security programs. As the name implies, entitlements tend to become politically difficult to change, as recipients come to feel entitled to what they have been receiving. Without changes, entitlements expenditure is expected to grow significantly in the coming years. Of all the entitlements, Medicare is expected to escalate in cost the most quickly, primarily due to the combined effects of anticipated rising health care costs and the expanding senior citizen population. Over the long term, without entitlements reform, taxes will have to be raised significantly, discretionary spending will have to be sharply reduced, or both. Entitlement Capital Net 2011 The sources for this glossary include the US Senate and the Congressional Deskbook. http://www.thecapitol.net/glossary/def.htm#Entitlement%20Program: Entitlement A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs. Entitlement Coalition of Human Needs CHN Glossary of Federal Budget Terms February 2004 http://www.democracyinaction.org/dia/organizations/chn/pdf/budgetglossary.PDF Entitlement: Program mandating the payment of benefits to any person meeting eligibility requirements established by statute. The amount spent is not controlled by annual congressional appropriations. Entitlement programs include Social Security, Medicare and Medicaid.

Entitlement Authority
Entitlement Authority Capital Net 2011 The sources for this glossary include the US Senate and the Congressional Deskbook. http://www.thecapitol.net/glossary/def.htm#Entitlement%20Program: Entitlement Authority A provision of law that requires payments to any person or unit of government that meets the eligibility requirements established by such law. Entitlements constitute a binding obligation on the part of the federal government, and eligible recipients have legal recourse if the obligation is not fulfilled. Entitlement legislation requires annual appropriations unless the existing appropriation is permanent. Examples of entitlement programs are Social Security benefits and veterans' compensation. Entitlement Authority AUSA Glossary Of Budget Terms Sept 29, 2005 ttp://www.ausa.org/SiteCollectionDocuments/ILW%20WebExclusivePubs/Special%20Reports/BudgetBook/08AppendixI.PDF Appendix I Entitlement authority is a provision of law that legally obligates the federal government to make specified payments to any person or government that meets the eligibility requirements established by that law. Example: Social Security. Obligations are binding agreements that will result in outlays, immediately or in the future.

Mandatory Spending
Mandatory Spending Kimberly Amadeo President of WorldMoneyWatch.com http://useconomy.about.com/od/glossary/g/mandatory_spend.htm Mandatory Spending Definition: Expenditures that must go into the U.S. budget that are mandated by programs outside of the budgetary process. These include Social Security, Medicare, Medicaid as well as Income Support programs such as Food Stamps and Veterans Retirement programs. Also Known As: Direct Spending, Entitlement Programs Examples: Mandatory spending within the U.S. budget will increase over the next ten years thanks to Social Security expenditures for retiring Baby Boomers. Mandatory Spending US Legal Definitions 2001 http://definitions.uslegal.com/m/mandatory-spending/ Mandatory Spending Law & Legal Definition Mandatory spending refers to spending enacted by law. Generally, a mandatory spending consists of entitlement programs. For example, Social Security benefits, and Medicare. The Congressional Budget Office (CBO) estimates costs of mandatory spending programs on a regular basis. However, Congress can affect spending on entitlement programs by changing eligibility requirements or the structure of programs. Mandatory Spending Office of Management and Budget Budget of the US Government, FY 2004 1/23/2003 http://www.gpoaccess.gov/usbudget/fy04/pdf/budget/glossary.pdf Mandatory Spending Mandatory spending is provided by permanent law rather than annual appropriations. An example is Social Security. The President and the Congress can change the law to the eligibility criteria or the payment formula, and thus change the level of spending on mandatory programs, but they dont have to take annual action to ensure the continuation of spending. See Discretionary Spending. Mandatory Spending Peter G Peterson Foundation Glossary November 08, 2010 http://www.pgpf.org/Special-Topics/glossary.aspx Mandatory Spending (Direct Spending): Sometimes referred to as being on auto-pilot, mandatory spending programs are funded each year through existing statutory provisions without requiring the Congress and the President to enact appropriations. Entitlement programslike Social Security, crop insurance, student loans, Medicare and Medicaidare considered mandatory programs. There are also non-entitlement mandatory programs such as federal insurance or guarantee programs that pay for claims without the need for annual appropriations. Mandatory spending also includes interest payments on the federal debt. (See also Entitlement, Discretionary Spending.) Mandatory Spending Coalition of Human Needs CHN Glossary of Federal Budget Terms February 2004 http://www.democracyinaction.org/dia/organizations/chn/pdf/budgetglossary.PDF Mandatory Spending: Federal spending on entitlement programs and interest on the national debt. Mandatory spending accounts for approximately two-thirds of all federal spending.

Direct Spending
Direct Spending Edward A. Zelinsky is a professor of law at the Benjamin N. Cardozo School of Law of Yeshiva University 2002 - Ohio Northern University Law Review Restoring Politics to the Commerce Clause: The Case For Abandoning The Dormant Commerce Clause Prohibition on Discriminatory Taxation Insofar as Professor Coenen's arguments track Professor Enrich's and the teachings of the tax expenditure school, the replies are also the same. Tax incentives and direct subsidies need not (and often do not) take the idealized forms central to tax expenditure analysis. Tax incentives can be and are structured to be of limited duration, thus requiring legislative renewal and review on expiration. Direct spending in entitlement form is "presumptively permanent" and thus beyond routine legislative scrutiny. In practice, most tax and spending policies are accepted as part of a baseline status quo which the legislature adjusts incrementally at the margins rather than reviews from scratch. Direct Spending Elizabeth Garrett Assistant Professor of Law, University of Chicago. January, 1999 - Cardozo Law Review Accountability and Restraint: The Federal Budget Process and the Line Item Veto Act n9. Most entitlement programs are essentially permanently appropriated; Congress enacts authority to spend money and the obligation to pay money arises without a periodic appropriation. Familiar entitlement programs are Medicaid, Medicare, and Social Security. Entitlement spending, which is also sometimes called mandatory spending, is a subset of direct spending. Direct spending is any spending pursuant to a binding legal obligation to pay, including, for example, interest on the national debt. Entitlement spending is by far the largest component of direct spending.

Discretionary Spending
Discretionary Spending Cramster 2011 http://www.cramster.com/definitions/discretionary-spending/341 Definition of Discretionary Spending Discretionary spending refers to the portion of government expenditures not fixed in amount by legal obligation in entitlement programs. According to the Office of Management and Budget (OMB), United States federal government entitlement program spending on Social Security, Medicaid, Medicare, interest on the national debt, and other mandated obligations totaled $2.5 trillion in 2009 (www.omb.gov). Discretionary expenditures in 2009 consisted of $0.7 trillion on national defense and $0.8 trillion on all other programs. Discretionary Spending Bankrupting America, July 17, 2011 http://www.bankruptingamerica.org/2010/07/definition-of-the-weekdiscretionary-spending/ discretionary spending: Unlike mandatory, or entitlement, spending, discretionary spending is optional spending which Congress allocates through the annual appropriations process. Most often, it is spending set aside for departments and agencies of the federal government to spend as they see fit in order to fulfill their appointed responsibilities. Discretionary Spending Kimberly Amadeo President of WorldMoneyWatch.com http://useconomy.about.com/od/glossary/g/mandatory_spend.htm Discretionary Spending Definition: Expenditures within the U.S. budget that are within the 13 appropriations bills, and are negotiated between the Branches of Congress and the President's Office each year. Examples: Defense is a large part of the discretionary spending portion of the U.S. Budget. Discretionary Spending Office of Management and Budget Budget of the US Government, FY 2004 1/23/2003 http://www.gpoaccess.gov/usbudget/fy04/pdf/budget/glossary.pdf Discretionary Spending Discretionary spending is what the President and the Congress decide to spend through annual appropriations bills. Examples include money for such activities as the FBI, the Coast Guard, housing and education, space exploration, highway construction, defense, and foreign aid. See Mandatory Spending. Discretionary Spending Peter G Peterson Foundation Glossary November 08, 2010 http://www.pgpf.org/Special-Topics/glossary.aspx Discretionary Spending: Discretionary spending results from annual appropriations legislation. Discretionary spending accounts for 35 percent of the budget (with more than half going to defense activities). Other areas of discretionary spending include: national parks, the Federal Aviation Administration, transportation programs, the Congress and the White House, elementary and secondary education, and State Department. (See also Mandatory Spending.) Discretionary Spending

Coalition of Human Needs CHN Glossary of Federal Budget Terms February 2004 http://www.democracyinaction.org/dia/organizations/chn/pdf/budgetglossary.PDF Discretionary Programs: Programs funded by annual congressional appropriations bills, except for appropriated entitlements such as veterans compensation. Under the Budget Enforcement Act, these expenditures are capped. Discretionary Spending Cap Coalition of Human Needs CHN Glossary of Federal Budget Terms February 2004 http://www.democracyinaction.org/dia/organizations/chn/pdf/budgetglossary.PDF Discretionary Spending Cap: Limits placed on the total amount of budget authority and outlays for discretionary programs Congress can provide in a given fiscal year. Discretionary Spending AUSA Glossary Of Budget Terms Sept 29, 2005 ttp://www.ausa.org/SiteCollectionDocuments/ILW%20WebExclusivePubs/Special%20Reports/BudgetBook/08AppendixI.PDF Appendix I Discretionary spending is what the President and Congress must decide to spend for the next fiscal year through 13 annual appropriation bills. Two of the annual appropriation bills (the Department of Defense Appropriation Bill and the Military Construction Appropriation Bill) pertain to the Department of Defense.

Welfare Spending
Welfare Spending http://www.libraryindex.com/pages/72/How-Much-Does-Nation-Spend-on-Welfare.html How Much Does the Nation Spend on Welfare? - Public Aid, State Expenditures For Social Welfare, Private Welfare Expenditures, Welfare-reform Legislation The U.S. Social Security Administration defines social welfare expenditures as the cost of "cash benefits, services, and the administration of public programs that directly benefit individuals and families." This broad definition includes expenditures for social security (OldAge, Survivor's, Disability, and Health Insurance, or OASDHI), health and medical programs, education, housing, veterans' programs, and public aid programs. In fiscal year 2000 (the last year for which combined information on social welfare expenditures from all sources is available) federal, state, and local governments spent about $1.01 trillion on social welfare programs. According to the Treasury Department's 2002 Financial Report of the U.S. Government, the total expenditure for social welfare in 2002 was slightly over 4 percent of the gross domestic product (GDP), the monetary total of the domestic goods and services produced by the United States. This reflects a drop of nearly one full percentage point since 1980 and about .75 percent since the early 1990s. Welfare Spending http://www.libraryindex.com/pages/72/How-Much-Does-Nation-Spend-on-Welfare.html While the Social Security Administration uses a broad definition of social welfare to categorize public expenditures, public welfare, or public aid, is generally taken to refer to cash or noncash assistance for lowincome persons. This narrower definition excludes social insurance programs such as Social Security and Medicare, which are considered entitlement programsthat is, programs to which people have a right because of contributions they have made from their earnings.

Social Welfare Expenditures

Social Welfare Expenditures http://www.libraryindex.com/pages/72/How-Much-Does-Nation-Spend-on-Welfare.html In 2000 about 56 percent of social welfare expenditures was dedicated to such entitlements as Social Security and Medicare. About 43 percent of social welfare spending was directed toward means-tested programs, including Medicaid and Temporary Assistance for Needy Families (TANF). This volume focuses on welfare programs that provide benefits or services to persons who are determined to be eligible based on a test of their income or "means." The federal government accounted for about 70 percent of total means-tested spending on social welfare, while state and local governments were responsible for the remaining 30 percent of meanstested expenditures in 2000. The proportion of expenditures at the federal and state level in each category of spending was very different, however. Outlays for medical benefits, primarily Medicaid, made up nearly half (43 percent) of federal welfare spending and about three-fourths (72 percent) of state and local welfare spending. On the other hand, expenditures on food assistance accounted for a little over 10 percent of the total federal welfare spending, while only 1.7 percent of state and local welfare costs funded food assistance programs. (See Table 1.1.) Federal social welfare expenditures remained relatively stable from 1980 to 2002, making up between 49 and 60 percent of all federal spending. However, expenditures on social welfare have been increasing as a percentage of state and local government costs. State and local spending for social welfare programs continued to increase into the early twenty-first century. This constant rise in costs was a major reason for the severe budget problems faced by local and state governments during the early 1990s. The problem was relieved somewhat by the strong economy of the mid-1990s, which helped the states to absorb these costs. When the economy began to weaken in 2000, however, the problem resurfaced. In 2002 public assistance, Medicaid, and other social welfare programs accounted for about a third of all state outlays.

Emergency Spending
Emergency Spending AUSA Glossary Of Budget Terms Sept 29, 2005 ttp://www.ausa.org/SiteCollectionDocuments/ILW%20WebExclusivePubs/Special%20Reports/BudgetBook/08AppendixI.PDF Appendix I Emergency spending is spending which the President and Congress have designated as an emergency requirement. Such spending is not subject to limits established on discretionary spending or pay-as-you-go rules established for direct (mandatory) spending.

Medicare
Medicare WonkWorld http://www.workworld.org/wwwebhelp/medicare_administration.htm Medicare - Administration The U.S. Department of Health and Human Services (DHHS) has the overall responsibility for administration of the Medicare program. Within DHHS, responsibility for administering Medicare rests with CMS. SSA assists, however, by initially determining an individual's Medicare entitlement, by withholding Part B premiums from the Social Security benefit checks of beneficiaries, and by maintaining Medicare data on the master beneficiary record, which is SSA's primary record of beneficiaries. The Internal Revenue Service in the Department of the Treasury collects the HI payroll taxes from workers and their employers. A Board of Trustees, composed of two appointed members of the public and four members who serve by virtue of their positions in the Federal Government, oversees the financial operations of the HI and SMI trust funds. The Secretary of the Treasury is the managing trustee. The Board of Trustees reports to Congress on the financial and actuarial status of the Medicare trust funds on or about the first day of April each year. State agencies (usually State Health Departments under agreements with CMS) identify, survey, and inspect provider and supplier facilities or institutions wishing to participate in the Medicare program. In consultation with CMS, these agencies then certify the facilities that are qualified. Medicare Peter G Peterson Foundation Glossary November 08, 2010 http://www.pgpf.org/Special-Topics/glossary.aspx Medicare: A health insurance program for senior citizens and those with disabilities enacted in 1965. The program, which has been modified and expanded several times since then, covers an estimated 45 million people. Medicare spending represented 12 percent of the federal budget in 2009 and 23 percent of the nations total health spending, and its costs are projected to double within the next decade. Like all health spending in the United States, Medicare costs are growing faster than the rest of the economy. Medicare covers people who are likely to have high health care costs, older Americans and the disabled. Due to an aging population and growth in health cost, the rising cost of Medicare represents the most difficult challenge in the federal budget. (See also Medicare Part A, Medicare Part B, Medicare Part D, and Medicaid.) Medicare Part A (Hospital Insurance Program): The Hospital Insurance program covers inpatient hospital care, hospice care, and some home health care expenses. Individuals are eligible for Medicare Part A when they turn 65 (without having to pay premiums) if they are also receiving Social Security or other government pension benefits. The program is funded by Medicare payroll taxes assessed on workers and employers. Medicare Part B: Medicare Part B is a voluntary program that covers physician-related expenses, outpatient and ambulatory care, and medical equipment. In most cases, individuals are automatically enrolled when they turn 65 if they are also receiving Social Security or other government pension benefits, though they may opt out. This program is funded by premiums deducted from monthly Social Security checks, and general revenue. Initially, the cost of the program was to be evenly divided between beneficiary premiums and general revenues. However, the share covered by general revenues has grown and now beneficiary premiums are generally set at a level that will cover 25 percent of costs. Medicare Part D (Prescription Drug Program): Enacted in 2003, the Medicare prescription drug program began providing benefits in 2006. It is a voluntary program that subsidizeds the cost of prescription drugs. The program is funded by general revenue and beneficiary premiums. Beneficiary premiums cover about 25 percent of costs. Medicare

West's Encyclopedia of American Law, edition 2. Copyright 2008 The Medicare Program provides basic healthcare benefits to recipients of Social Security and is funded through the Social Security Trust Fund. President Harry S. Truman first proposed a medical care program for the aged in the late 1940s, but it was not enacted until 1965, when Medicare was established as one of President Lyndon B. Johnson's Great Society programs (42 U.S.C.A. 1395 et seq.). The Medicare Program is administered by the Health Care Financing Administration (HCFA). The federal government enters into contracts with private insurance companies for the processing of Medicare claims. To qualify for Medicare payments for their services, healthcare providers must meet state and local licensing laws and standards set by the HCFA. Medicare is divided into a hospital insurance program and a supplementary medical insurance program. The Medicare hospital insurance plan is funded through Social Security payroll taxes. It covers reasonable and medically necessary treatment in a hospital or skilled nursing home, meals, regular nursing care services, and the cost of necessary special care. Medicare's supplementary medical insurance program is financed by a combination of monthly insurance premiums paid by people who sign up for coverage and money contributed by the federal government. The government contributes the major portion of the cost of the program, which is funded out of general tax revenues. Persons who enroll pay a small annual deductible fee for any medical costs incurred above that amount during the year and also a regular monthly premium. Once the deductible has been paid, Medicare pays 80 percent of all bills incurred for physicians' and surgeons' services, diagnostic and laboratory tests, and other services, but does not pay for routine physical checkups, drugs, and medicines, eyeglasses, hearing aids, dentures, and orthopedic shoes. Doctors are not required to accept Medicare patients, but almost all do. Medicare's hospital insurance is financed by a payroll tax of 2.9 percent, divided equally between employers and employees. The money is placed in a trust fund and invested in U.S. Treasury Securities. The fund accumulated a surplus during the 1980s and early 1990s. It was projected that the fund would run out of money by the early 2000s as outlays arose more rapidly than future payroll tax revenues, but this proved not to be the case. Medicare Employment Support Institute, VCU School of Business 01/26/2011 http://www.workworld.org/wwwebhelp/medicare_administration.htm Medicare Administration The U.S. Department of Health and Human Services (DHHS) has the overall responsibility for administration of the Medicare program. Within DHHS, responsibility for administering Medicare rests with CMS. SSA assists, however, by initially determining an individual's Medicare entitlement, by withholding Part B premiums from the Social Security benefit checks of beneficiaries, and by maintaining Medicare data on the master beneficiary record, which is SSA's primary record of beneficiaries. The Internal Revenue Service in the Department of the Treasury collects the HI payroll taxes from workers and their employers. A Board of Trustees, composed of two appointed members of the public and four members who serve by virtue of their positions in the Federal Government, oversees the financial operations of the HI and SMI trust funds. The Secretary of the Treasury is the managing trustee. The Board of Trustees reports to Congress on the financial and actuarial status of the Medicare trust funds on or about the first day of April each year. State agencies (usually State Health Departments under agreements with CMS) identify, survey, and inspect provider and supplier facilities or institutions wishing to participate in the Medicare program. In consultation with CMS, these agencies then certify the facilities that are qualified. Medicare Medicare Early Access Act of 2008 - 110th Congress, 2nd Session IN THE SENATE OF THE UNITED STATES AS INTRODUCED IN THE SENATE S. 3710 2008 S. 3710; 110 S. 3710 'SEC. 1860E-1. PROGRAM BENEFITS; ELIGIBILITY. '(a) Entitlement to Medicare Benefits for Enrolled Individuals.-'(1) IN GENERAL.--An individual enrolled under this part is entitled to the same benefits under this title as an individual entitled to benefits or enrolled under any part of this title.

'(2) DEFINITIONS.--For purposes of this part: '(A) FEDERAL OR STATE COBRA CONTINUATION PROVISION.--The term 'Federal or State COBRA continuation provision' has the meaning given the term 'COBRA continuation provision' in section 2791(d)(4) of the Public Health Service Act and includes a comparable State program, as determined by the Secretary. '(B) FEDERAL HEALTH INSURANCE PROGRAM DEFINED.--The term 'Federal health insurance program' means any of the following: '(i) MEDICARE.--Any part of this title (other than by reason of this part). '(ii) MEDICAID.--A State plan under title XIX. '(iii) FEHBP.--The Federal employees health benefit program under chapter 89 of title 5, United States Code. '(iv) TRICARE.--The TRICARE program (as defined in section 1072(7) of title 10, United States Code). '(v) ACTIVE DUTY MILITARY.--Health benefits under title 10, United States Code, to an individual as a member of the uniformed services of the United States. '(C) GROUP HEALTH PLAN.--The term 'group health plan' has the meaning given such term in section 2791(a)(1) of the Public Health Service Act. '(b) Eligibility of Individuals Age 55 to 65 Years of Age.-'(1) IN GENERAL.--Subject to paragraph (2), an individual who meets the following requirements with respect to a month is eligible to enroll under this part with respect to such month: '(A) AGE.--As of the last day of the month, the individual has attained 55 years of age, but has not attained 65 years of age. '(B) MEDICARE ELIGIBILITY (BUT FOR AGE).--The individual would be eligible for benefits under part A or part B for the month if the individual were 65 years of age.

Social Security
Social Security Peter G Peterson Foundation Glossary November 08, 2010 http://www.pgpf.org/Special-Topics/glossary.aspx Social Security: A social insurance program that supplements retiree income through monthly cash payments. The program also provides benefits to the survivors of deceased workers and spouses of retired workers. Established in 1935, the program is funded by a payroll tax assessed on both employers and employees and consequently operates as a form of income transfer from workers to retirees. Most American workers are eligible to receive benefits if they have worked for the required minimum number of years, paid payroll taxes, and meet other requirements such as the eligibility age for retirement benefits. The full retirement age is 65 for those born in 1937 and earlier. Since reforms enacted in the 1980s, the full retirement age has been rising gradually. It is 67 for those born in 1960 and later. The early retirement age is 62. As the baby boom generation begins to retire, costs of the program are expected to swell. (See also Entitlement Programs and Trust Fund.) Social Security The American Heritage Dictionary of the English Language, Fourth Edition copyright 2000 social security n. 1. often Social Security Abbr. SS A government program that provides economic assistance to persons faced with unemployment, disability, or agedness, financed by assessment of employers and employees. 2. The economic assistance provided by social security. Social Security West's Encyclopedia of American Law, edition 2. Copyright 2008 A federal program designed to provide benefits to employees and their dependants through income for retirement, disability, and other purposes. The social security program is funded through a federal tax levied on employers and employees equally. The Social Security Program was created by the Social Security Act of 1935 (42 U.S.C.A. 301 et seq.) to provide old age, survivors, and disability insurance benefits to the workers of the United States and their families. The program, which is administered by the Social Security Administration (SSA), an independent federal agency, was expanded in 1965 to include Health Insurance benefits under the Medicare program and to assist the states in establishing Unemployment Compensation programs. Unlike Welfare, which is financial assistance given to persons who qualify on the basis of need, Social Security benefits are paid to an individual or his family on the basis of that person's employment record and prior contributions to the system. Social Security West's Encyclopedia of American Law, edition 2. Copyright 2008 Federal Old Age, Survivors, and Disability Insurance (OASDI) benefits are monthly payments made to retired people, to families whose wage earner has died, and to workers who are unemployed because of sickness or accident. Workers qualify for such protection by having been employed for the mandatory minimum amount of time and by having made contributions to Social Security. There is no financial need requirement to be satisfied. Once a worker qualifies for protection, his family is also entitled to protection. The entire program is geared toward helping families as a matter of social policy. Two large funds of money are held in trust to pay benefits earned by people under OASDI: the Old Age and Survivors Trust Fund and the Disability Insurance Trust Fund. As workers and employers make payroll contributions to these funds, money is paid out in benefits to people currently qualified to receive monthly checks. The OASDI program is funded by payroll taxes levied

on employees and their employers and on the self-employed. The tax is imposed upon the employee's taxable income, up to a maximum taxable amount, with the employer contributing an equal amount. The selfemployed person contributes twice the amount levied on an employee. In 2003 the rate was 6.2 percent, levied on earned income up to a maximum of $87,000. Old Age Benefits A person becomes eligible for Social Security old age benefits by working a minimum number of calendar quarters. The number of quarters required for full insurance increases with the worker's age. Forty quarters is the maximum requirement. The individual is credited for income up to the maximum amount of money covered by Social Security for those years. This amount is adjusted to reflect the impact of inflation on normal earnings and ensure that a worker who pays increasing Social Security contributions during his or her work life will receive retirement benefits that keep pace with inflation. Persons born before 1950 can retire at age 65 with full benefits based on their average income during their working years. For those born between 1950 and 1960, the retirement age for full benefits has increased to age 66. Persons born in 1960 or later will not receive full retirement benefits until age 67. Any person, however, may retire at age 62 and receive less than full benefits. At age 65, a worker's spouse who has not contributed to Social Security receives 50 percent of the amount paid to the worker.

Reform
Reform Random House Dictionary, 2011. reform [ri-fawrm] Show IPA noun 1.the improvement or amendment of what is wrong, corrupt, unsatisfactory, etc.: social reform; spelling reform. 2.an instance of this. 3.the amendment of conduct, belief, etc. Reform World English Dictionary reform (rfm) n 4. an improvement or change for the better, esp as a result of correction of legal or political abuses or malpractices 5. a principle, campaign, or measure aimed at achieving such change 6. improvement of morals or behaviour, esp by giving up some vice [C14: via Old French from Latin reformre to form again] Reform Merriam-Webster's Dictionary of Law, 1996 Main Entry: reform Function: transitive verb 1 : to put (a writing) into a corrected form that more accurately reflects the agreement of the parties reform ed W. M. McGovern, Junior et al. > compare RATIFY 2 : to induce or cause to abandon wrongful or harmful ways reformed drug dealer> intransitive verb : to become changed for the better

Medicare Reform
Medicare Reform Dan Pierce, eHow Contributor What Is Medicare Reform? http://www.ehow.com/facts_5869665_medicarereform_.html Medicare is the health insurance component of Social Security, providing coverage for the elderly. According to Webster's Dictionary, reform is "to amend or improve by change of form or removal of faults or abuses." History Medicare was passed by Congress in 1965. According to "Medicare: History of Provisions," Congress has made numerous changes or additions to the Medicare program in the years since original passage. Coverage Medicare is divided into Part A (hospital insurance), Part B (medical insurance) and Part D (prescription drug coverage). Funding Medicare Part A is funded primarily through payroll taxes. Parts B and D are financed primarily through allocations from general revenue by Congress. All three are administered by six trustees who also oversee the Social Security trust fund. Funding Issues According to the 2009 trustees' report, "Medicare's financial difficulties come sooner--and are much more severe--than those confronting Social Security." The report predicts a funding shortfall for Medicare Part A by 2012, and Hospital Insurance Trust Fund exhaustion by 2017. Meaning of Reform While "Medicare Reform," through most of the history of the program was generally seen as changing the program to add or re-define benefits and eligibility, in recent years the phrase has come to mean efforts to either deal with the increasing cost of the program, or the program's position within the overall issue of health insurance reform.

Social Security Reform

Social Security Reform V2 Vocabulary Building Dictionary http://vocabulary-vocabulary.com/dictionary/reform.php reform verb, noun Definition: (v.) 1. to improve something by changing it for the better; 2. to get rid of something unacceptable, especially in personal habits; (n.) 1. the reorganization and improvement of something; 2. self-improvement Synonyms: (v.) improve, reorganize, restructure, amend, redeem, (n.) improvement Antonyms: corrupt, degrade, abase Tips: Reform's literal meaning is "to form again." When you reform something, you recreate it in order to improve it. Reform is used in both the verb and noun form. Political reform is a popular use. For example, Social Security reform is when politicians "form" the Social Security program in a new way--they reform it. Usage Examples: I decided to start my personal reform by quitting smoking. (improvement) noun Many people believe that America's social security system is in desperate need of reform. (reorganization, restructuring, improvement) noun He has tried to reform several times, but each time, he slides back into his corrupt ways. (improve, redeem [himself]) verb We reformed our reporting system to make it more streamlined. (improved, restructured) verb The Conservative Definition of Social Security Reform February 8, 2007 http://www.iwf.org/inkwell/printer/18025.html

10. Resource Materials:

Primary Sources: Two of the most important documents to examine would be the reports by the Boards of Trustees of the Social Security Trust Fund and the Medicare Trust Fund. Both of these organizations are required, by statute, to report each year on the financial status of each of the programs, and to give projections about the programs fiscal stability in the future. They can be found at: Medicare: https://www.cms.gov/ReportsTrustFunds/downloads/tr2011.pdf Social Security: http://www.ssa.gov/OACT/TR/2011/index.html The Congressional Budget Office also releases reports on the stability of the programs. They have Issue Areas dedicated to the programs on their website, each with multiple reports and documents. Social Security: http://www.cbo.gov/publications/collections/collections.cfm?collect=5 The Health Care page has an expandable list for Medicare: http://www.cbo.gov/ftpdocs/87xx/doc8758/HealthTOC.1.1.htm One of the comprehensive reports is the 2007 Sustainability Report: http://www.cbo.gov/ftpdocs/87xx/doc8758/HealthTOC.1.1.htm The Social Security Administration and the Medicare Program both have .gov websites, although most of those websites are dedicated to applications and eligibility information, rather than advocacy literature. http://www.ssa.gov/pubs/#Medicare http://www.medicare.gov/default.aspx?AspxAutoDetectCookieSupport=1 The Medicare website does have a good Glossary of terms http://www.medicare.gov/Glossary/Search.asp?SelectAlphabet=ALL&Language=English#Content Advocacy Groups As explained in Sections 5 and 6 above, a crucial resource for this topic would be Think Tanks and Advocacy groups. Many important think tanks have Issue Areas dedicated to Social Security and Medicare or Entitlements. These alone would provide a substantial basis for the literature base of the topic. Cato Institute: http://www.cato.org/social-security http://www.cato.org/medicare-medicaid http://www.cato.org/health-savings-accounts Heritage Foundation: http://www.heritage.org/Issues/Health-Care/Public-Health-Program-Reform/Medicare http://www.heritage.org/Issues/Retirement-Security/Social-Security

Brookings Institute: http://www.brookings.edu/topics/social-security.aspx http://www.brookings.edu/topics/medicare.aspx Center for Economic and Policy Research: http://www.cepr.net/index.php/component/option,com_issues/Itemid,22/issue,19/lang,en/task,vie w_issue/ http://www.cepr.net/index.php/component/option,com_issues/Itemid,22/issue,10/lang,en/task,vie w_issue/ ThinkProgress: http://thinkprogress.org/?s=social+security&x=0&y=0 http://thinkprogress.org/?s=medicare&x=0&y=0&fqtags=Politics^^Medicare The Hudson Institute: http://www.hudson.org/index.cfm?fuseaction=research_publications_list&resType=SocialSec There are some specialized think tanks that Only deal with entitlement spending. Two Prominent ones: The Peter G. Peterson Foundation (not the Peter G Peterson Institute different site) http://www.pgpf.org/Special-Topics/HJ-Social-Security.aspx The Social Security Institute: http://socialsecurityinstitute.com/ Some of the Links for the Phony Crisis debate: Mark Weisbrot Demographic Tidal Waves and Other Myths: Social Security and Medicare The Elder Law Journal 2001 http://www.pepperinstitute.org/research/barabas/POQ_BankruptRhetoric.pdf http://robertdfeinman.com/society/medicare.html http://www.press.uchicago.edu/Misc/Chicago/035468.html http://prospect.org/cs/articles?article=isocial_security_the_phony_crisis/i http://www.iea-macro-economics.org/ss-priv.html http://www.signonsandiego.com/uniontrib/20041209/news_lz1e9krugman.html http://www.cato.org/pub_display.php?pub_id=1607 http://monthlyreview.org/1983/02/01/social-security-the-phony-crisis http://hij.sagepub.com/content/11/1/9.short http://www.springerlink.com/content/y666q2316g272325/ Solvency Mechanisms Dick Day, member of the Minnesota State Senate 2007 [Should Medicare be Means-Tested? A Symposium is a nonpartisan, tax-exempt, public policy and educational institution MAY http://www.americanexperiment.org/ uploaded/ files/should _medicare_be_meanstested.pdf Grover Norquist, president of Americans for Tax Reform 2007 [Reform, Yes. Cut, No. Should Medicare be Means-Tested? A Symposium is a nonpartisan, tax-exempt, public policy and educational institution MAY http://www.americanexperiment.org/uploaded/ files/should _medicare_be_meanstested.pdf

Richard Kaplan, Prof University of Illinois College of Law 2006 [http://ssrn.com/abstract=918100 Law and Economics Research Paper Series Research Paper No. LE06-019 Means-Testing Medicare: Retiree Pain for Little Governmental Gain JOURNAL OF RETIREMENT PLANNING May June National Committee to Preserve Social Security and Medicare [http://www.ncpssm.org/news/archive/vp_ meanstesting/ Government Relations and Policy, July National Committee Position Stuart Butler, Domestic and Economic Policy Studies at The Heritage Foundation, 2008 [Rethinking Social Insurance, Feb 19 Heritage Foundation White Paper, http://www.heritage.org/Research/Budget/wp021908.cfm) Ralph McCutchen, chairman, Senior Citizens League 2006 [ Senior Journal September 1, Opinion: Medicare Means Testing a Costly Slip http://seniorjournal.com/NEWS/Opinion/6-09-11OpinionMedicareMeansTesting.htm Marilyn Moon Vice President and Director of the Health Program at American Institutes for Research 2004 [Medicare Means-Testing: A Skeptical View http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.558/DC1 8 December Current Medicare Proposals Associated Press. May 9, 2011. (May 9 2011, http://www.google.com/hostednews/ap/article/ALeqM5jabdDQQTJAshOKcsA6sKpzSAzcMw?docId =2ff8c06459bc4edc9350826cb150ba66, Despite differences, Obama, GOP eye Medicare limit. Associated Press.) Salon. April 13, 2011. (April 13, 2011. http://www.salon.com/technology/how_the_world_works/2011/04/13/obama_deficit_reduction_s peech. Obama climbs back into the ring. Salon. ) Huffpost Politics. April 25, 2011 (April 25 2011, http://www.huffingtonpost.com/2011/05/25/paulryan-medicare-gene-sperling_n_866860.html, Top Obama Aide Compares 'Poorly Designed' Ryan Budget To His Own Basketball Skills: 'Slow,' 'Can't Jump'. Huffpost Politics.) Daily Democrat April 27, 2011 (April 27, 2011, http://www.dailydemocrat.com/guestopinions/ci_18153577, Espo: Will Medicare redo 2012? Daily Democrat. The Christian Science Monitor April 5, 2011 (Peter Grier, staff writer, Medicare: How Paul Ryan's budget would change it, http://www.csmonitor.com/USA/Politics/2011/0405/Medicare-How-PaulRyan-s-budget-would-change-it) The Washington Post February 1, 2010 (Ezra Klein, Washington Post columnist, Rep. Paul Ryan's daring budget proposal, http://voices.washingtonpost.com/ezraklein/2010/02/rep_paul_ryans_daring_budget_p.html) Center for American Progress April 12, 2011 (Tony Carrk, policy analyst at American Progress, Ryans Budget Attempts to End Medicare and Shift Costs to Seniors, http://www.americanprogress.org/issues/2011/04/ryan_medicare.html)

Congressional Budget Office April 5, 2011 (Douglas Elmendorf, Long-Term Analysis of a Budget Proposal by Chairman Ryan, http://cbo.gov/ftpdocs/121xx/doc12128/04-05Ryan_Letter.pdf) TIME Magazine April 6, 2011 (Kate Pickert, staff writer for TIME and reform editor of the New York Times, The Nitty-Gritty Details of Paul Ryans Medicare Plan, http://swampland.time.com/2011/04/06/the-nitty-gritty-details-of-paul-ryan%E2%80%99smedicare-plan/)