Entitlement Reform

8/3/2019 Entitlement Reform

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Entitlement Reform

Proposed Topic for the 2012-2013 High School Policy Debate TopicFor the National Federation of State High School Associations

Tim AldereteJoshua ReismanIsabella LeeTheo KwanAaron NovickThe Meadows School


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1. Summary

Title: Entitlement Reform A proposed topic for the 2012-2013 High School policy debate topictopic.

Recommended Resolutions:

1. Resolved: the United States federal government should substantially reduce its spending forMedicare and/or Social Security.

2. Resolved: the United States federal government should substantially reduce Medicare and/orSocial Security spending.

3. Resolved: the United States federal government should substantially limit the growth of Medicareand/or Social Security spending.

4. Resolved: the United States federal government should substantially reduce Medicare and/orSocial Security benefits.

Types of affirmative cases: Affirmative teams would have a wide range of options for planmechanisms. Reducing benefits, reducing Who Gets benefits, reducing administrative costs, orlimiting what type of medical procedures benefits will cover all are Areas for different cases, withmultiple specific plan mechanisms in each Area. Other affirmative teams will opt for privatizationschemes. Finally, teams can choose to phase out entitlement spending entirely. Affirmative advantageareas will focus on the long term financial stability of the US government, with the attendanteconomic 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 aboutmandatory government programs and taxation.

Types of negative approaches that would be utilized: The negative will be assured of groundrelated to restricting spending or benefits. This carries with it economic and retirement securityimpacts. Negatives will have substantial opportunity to address the system collapse through apowerful set of counterplans, from employment promotion, to restructuring, to increasing taxrevenue, as well as other forms of entitlement reform that compete within the literature. The politicalbacklash disadvantage will be the most important on the topic.

Debatability of the topic: For the Negative, there would be a significant amount of MechanismPredictability, as there is a direction to the resolution. The advantage ground is more limited, but isvery deep and balanced. The literature base for both sides is enormous. The potential impacts arecomparable in size, scope and interest.


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Paragraph Synopsis: Government debt is rapidly increasing. The primary cause is the structuralgrowth of entitlement spending. Programs like Social Security and Medicare, which for decades haveproduced surpluses that were directed into trust funds, soon will start to produce deficits. Insufficientfunds were placed in trust, and those trust funds were used to finance government discretionaryspending. The retirement of the Baby Boomers will break both systems, and push government deficitsand debt beyond stable limits. Within fifty years, all government revenue from taxes will be needed tocover entitlement benefits and the interest on the debt owed to their trust funds. We will be forced toeither 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, butwe must begin now by reducing spending. No amount of administrative shuffling or revenue increasescan overcome the structural increases in benefits. Affirmatives would specify types of cuts to make, ormay choose to phase out the system in favor of privatization. The negative will be able to defend thepromise that the government has made over the years to protect its citizens in their retirement, andthe benefits that they have invested into for their entire lives.


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2. Introduction:

Social Security and Medicare are retirement security programs that aim to guarantee a basic level ofincome 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 trustfunds. The mandatory nature of the taxation and the guaranteed nature of the benefits have causedthese programs to be called entitlements. This is also known as Mandatory Spending or DirectSpending (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 notan 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 financialbenefits to which an indefinite . number of potential beneficiaries have a legal right (enforceablein court, if necessary) whenever they meet eligibility conditions that are specified by the standing lawthat authorizes the program. For decades, workers have paid into these programs, with taxesdeducted from their paychecks, with the expectation that when they retire, they will receive thebenefits that they are entitled to. That is the promise.

Medicare has four different parts which cover different aspects of retirement health care throughdifferent 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, helpspay 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 payfor physician, outpatient hospital, home health, and other services for the aged and disabled whohave voluntarily enrolled. Part D provides subsidized access to drug insurance coverage on avoluntary basis for all beneficiaries and premium and cost-sharing subsidies for low-incomeenrollees. Medicare also has a Part C, which serves as an alternative to traditional Part A and PartB coverage. Under this option, beneficiaries can choose to enroll in and receive care from privateMedicare 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 andSMI Part B trust fund accounts.

The 2011 annual report of the Board of Trustees of the Federal Old-age and Survivors Insurance andFederal 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 makesavailable 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 paybenefits to workers and their familiesOld-Age and Survivors Insurance (OASI) and DisabilityInsurance (DI). Under OASI, monthly benefits are paid to retired workers and their families and tosurvivors of deceased workers. Under DI, monthly benefits are paid to disabled workers and theirfamilies.

Opposition to Social Security and Medicare has existed from their very establishment. Critics opposethe 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 andcontinuing, Medicare and Social Security have become some of the most popular governmentprograms, 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.


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A different criticism, one that began in the early 1980s, but has gained substantial traction recently, ithat the programs must be reformed in order to Save them that they are financially unstable, andwill eventually collapse unless something is done now. A variety of different explanations for thefinancial shortfall exist from a demographic shift toward a retiring and aging population, to risinghealth care costs, to intergovernmental debt. Whatever the cause of the financial problems, it is nolonger taboo to call for reform. The Affordable Care Act [Obamas health care legislation] enactedsubstantial changes to Medicare benefits, Representative Paul Ryan introduced legislation to overhaulMedicare 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, andSenate leadership has indicated that they are open to discussing the issue. CNN reports this monththat even lobbying groups for seniors, like the AARP, have communicated to Congress their interest inreforms to Social Security that reduce benefits. [AARP expects Social Security benefit cuts, JeanneSahadi June 17, 2011] Once the Third Rail of politics, reforming Social Security and Medicare hasbecome the Litmus Test for political maturity in coming years.

While the universal opposition reform has changed, this does not mean that real reforms will passsoon. Despite a quick start and vocal support from fiscal conservatives, many Republicans are backingaway from supporting any reforms that would reduce Medicare benefits. The Special Election in fillNew 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, thepublic's reception to the Medicare overhaul championed by House Republicans. Lawrence Hunter ofthe Social Security Institute believes that long-range entitlement reform and balanced budgetamendments should be off the table in budget and debt-ceiling discussions they are a bridge too farunder the current circumstances, unobtainable under the current political power configuration. Hecontinues that unless Congress is willing simply to cut current entitlement benefits, no seriousentitlement reform can help the deficit/debt situation in the short run. [Hunter 2011 Rules forReforming our Bloated Welfare State]

The most prominent advocate for change has been Congressman Paul Ryan. Rep. Ryan has proposedlegislation 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, youngerworkers, once they have reached the age of eligibility, will be given a Medicare payment and a list ofguaranteed coverage options from which they can then choose. Moreover, all potential savingsallocated to the current health care law would go to shoring up Medicare, and not for new forms ofentitlements. The budget also offers a strategy of fixing the current Medicare physician paymentformula. It provides a reimbursement system that compensates physicians who treat Medicarebeneficiaries. Ryan proposes what he calls a premium-support model. This premium-support modelwould operate in a way similar to the way the Medicare prescription-drug benefit program works nowThe Medicare premium-support payment would be paid, by Medicare, to the plan chosen by thepatient, thus subsidizing the cost. The payment would be adjusted so that wealthier beneficiarieswould 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. Healthplans that choose to participate in the exchange would have to offer insurance to all Medicarebeneficiaries. 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 ofMedicaid.

In Obamas reaction to Rep. Ryans budget, Obama recommitted to healthcare reform, declaring thatthe savings his plan would seek from Medicare and Medicaid would be a result of consolidating andadvancing the cost control initiatives included in the Affordable Care Act and the goal, he said, is tolower the cost of healthcare, instead of reducing the level of government commitments to the elderlyand the poor. Obamas plan would keep Medicare a government program but give a panel of experts


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


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3. Affirmative Ground:

Harms:

The core issue addressed by this topic is the fiscal insolvency of the US federal government. Debt anddeficits are rising, and the prime reasons are Medicare and Social Security spending. There are severareasons that Medicare and Social Security spending costs are rising.

First Demographic shift. When these programs were established, the majority of the Americanpopulation was younger. Larger percentages of the population were employed, and therefore werepaying 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 higherpercentage of the population is retired. This means that the number of people paying into the systemhas 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 thecost 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: Althoughthe aging of the population is frequently cited as a major factor it accounts for a modest fraction ofthe growth that the Congressional Budget Office (CBO) projects. The main factor is excess costgrowthor the extent to which the increase in health care spending for an average individual exceedsthe growth in per capita gross domestic product (GDP). [The Long-Term Outlook for Health CareSpending 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 surplusof money coming into the programs due to the younger population, those surpluses went into TrustFunds for the programs. The idea was that these Trust Funds would cover the shortfalls during theyears 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 fundsare Treasury Securities IOUs from the federal government that become a part of our annual debtservicing. This means that when Trust Fund monies need to be used to cover short falls whendedicated payroll taxes can no longer cover benefits, general federal revenues will need to beappropriated to cover those shortfalls and to service the debts on the Treasury Securities. The concernis that those increased general revenue costs will swamp any money available for DiscretionarySpending.

Jim Powell 2010 - the Cato Institute [A Flashpoint for Social Securityhttp://www.cato.org/pub_display.php?pub_id=12094

On August 5th, Social Security trustees released their report showing that permanent annualSocial Security deficits will begin in 2015 Since there are more than 50 million Social Securitybeneficiaries, and their numbers are growing faster than the number of taxpayers, there will beintense, politically irresistible pressure to continue paying benefits by raising payroll taxes andincome taxes. But taxes won't be enough to save Social Security, because Medicare and Medicaidare also going broke, and payments on all the debt are skyrocketing. Social Security was set up tohave each person pay for somebody else's benefits. Current payroll taxes go to pay current SocialSecurity benefits, and nothing is set aside for the future retirement of people working now. In thepast, when current payroll taxes exceeded current benefits, the Social Security Administrationused the surplus to buy special issue U.S. Treasury bonds. The surplus was mingled with thegovernment's general funds and immediately spent on other programs. Now that Social Security is


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in deficit, the Social Security Administration will start redeeming those bonds, and the Treasurywill draw on current revenues other than payroll taxes. The money is long gone. There is noinvestment fund, no lockbox.

The impacts to this shortfall will be enormous, both in their impact on the economy and on ournational 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 NewHampshire, the ranking Republican on the Senate Banking Committee. On a 75-year basis, SocialSecurity is bankrupt: Promised benefits far exceed estimated revenues, and if all future benefitsbeyond this time frame are included, the unfunded liabilities are nearly $16 trillion. If Medicare isincluded, the unfunded liabilities soar to more than $100 trillion. That's the amount in today'sdollars that is needed to pay off all future benefits over and above taxes collected . PresidentObama's debt and deficit commission cannot afford to ignore these massive contingent liabilitiesand 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 interestrates 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 growfaster than the economy, and they will take more than 100 percent of all federal tax revenue thisyear, requiring that virtually all of the other government spending programs, including defenseand interest payments on the debt, be funded by more borrowingThe best that any tax increasecould do is delay the explosion of the debt bomb by, perhaps, a couple of years while furtherweakening 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 yourgovernment holds about $1 trillion in U.S. government securities. You have watched Congress andthe administration become less and less fiscally responsible more spending, more taxes, andmore debt. The Chinese are not stupid, and they have been vocal in saying they are concernedthat U.S. policies will lead to a further fall in the dollar and higher rates of inflation, both of whichundermine the value of their investment in U.S. government securities. When the debt bombexplodes within the next one to three years expect to see record high real interest ratesand/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 Securityhttp://www.nationalreview.com/articles/259024/economy-and-national-security-zalmay-khalilzadIf 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 Statesposition as global leader. While the United States suffers from fiscal imbalances and low economicgrowth, the economies of rival powers are developing rapidly. The continuation of these twotrends could lead to a shift from American primacy toward a multi-polar global system, leading in
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turn to increased geopolitical rivalry and even war among the great powers. The current recessionis the result of a deep financial crisis, not a mere fluctuation in the business cycle. Recovery islikely to be protracted. The crisis was preceded by the buildup over two decades of enormousamounts of debt throughout the U.S. economy ultimately totaling almost 350 percent of GDPWithout faster economic growth and actions to reduce deficits, publicly held national debt isprojected to reach dangerous proportions. If interest rates were to rise significantly, annualinterest payments which already are larger than the defense budget would crowd out otherspending 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 asovereign-debt crisis that would almost certainly compel a radical retrenchment of the UnitedStates internationally. Such scenarios would reshape the international order. . The closing of thegap between the United States and its rivals could intensify geopolitical competition among majorpowers, increase incentives for local powers to play major powers against one another, andundercut our will to preclude or respond to international crises because of the higher risk ofescalation. The stakes are high. In modern history, the longest period of peace among the greatpowers 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 greatpowers. Failures of multi-polar international systems produced both world wars.


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Potential Plans:

Privatization

Many authors, particularly at libertarian think tanks, have long argued that Medicare and SocialSecurity, as government run programs, displaced more efficient and effective private markets. Thatretirement accounts or health savings accounts provided by private lenders gave individuals morechoice 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 Ryanproposal, many advocate allowing individuals to Opt Out of Medicare or Social Security that theywould no longer have those taxes removed from their payrolls and using tax credits to encourageworkers to invest in individual retirement accounts or health savings accounts. Alternatively, insteadof receiving Social Security or Medicare benefits, seniors could choose to invest their benefits in theform of a voucher in private accounts.

For Social Security, global empirical examples are often held up as proof that privatizing SocialSecurity will work.

Daniel Mitchell, 2011 [http://www.cato-at-liberty.org/the-case-for-social-security-personal-

accounts/The Case for Social Security Personal Accounts

Other nations have figured out the right approach. Australia began to implement personalaccounts back in the mid-1980s, and the results have been remarkable. The governments financesare stronger. National saving has increased. Another great example is Chile, which set uppersonal accounts in the early 1980s. . All told, about 30 nations around the world have set upsome form of personal accounts. Even Sweden, which the left usually wants to mimic, has partiallyprivatized its Social Security system. It also should be noted that personal accounts would be goodfor growth and competitiveness. Reforming a tax-and-transfer entitlement scheme into a systemof private savings will boost jobs by lowering the marginal tax rate on work. Personal accounts alsowill 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 fiscalcrisis 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 thesavings account to pay for medical procedures, giving the consumer an incentive to find the leastexpensive care, and to forgo unnecessary care. This addresses the root cause of Medicare collapsehigh health care costs.

Shikha Dalmia, senior analyst with the Reason Foundation 2007 [Should Medicare be Means-Tested? A Symposium is a nonpartisan, tax-exempt, public policy and educational institution MAYhttp://www.american experiment.org/uploaded/ files/should _medicare_be_meanstested.pdf

The second possibility is a consumer-driven system in which employers and government, insteadof purchasing health insurance for employees or Medicare beneficiaries, give people a fixedamount to spend on their health care needs. Indeed, putting consumers in charge of their ownhealth care dollars is a far better way of putting Medicare on a sound fiscal footing than means-testing 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. Means-testing 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, andfederal general revenues pick up the rest of the tab. Yet asking wealthier seniors, who also tend tobe healthier, to pay more will drive them out of the program, raising premiums for those


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remaining. Far better would be to give the $300 billion or so the federal government spends onMedicare directly to seniors so they could combine it with their out-of-pocket expenses and buyhealth insurance as they see fit. Consumer-driven reforms might mean that seniors will have toshop around and think before consuming medical services, just as they do before buying groceriesor clothes or other essentials. But self-rationing of health care is far better than rationing by queueor by bureaucratic fiat.

Raising the Age Requirement:

One way to reduce spending on Social Security or Medicare would be to reduce the number of peoplewho qualify for the benefits. Currently, the FRA (Federal Retirement Age) is 65. Seniors born before1960 qualify for Social Security at that age, and for those born after, they are eligible at 67. Raisingthat age would substantially reduce the spending for those programs and can head off the financialcrisis

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, onaverage, healthier than their counterparts of 40 years ago. But many of these same people despairthat it could ever be done. Yet we have a case where just something like that was done: the SocialSecurity reforms of 1983 one Democratic Congressman, Jake Pickle from Texas, bravely addedan amendment and got it through. That amendment raised the Social Security age, in steps and inprospect, from 65 to 67. No one could argue that he wouldn't have time to plan because theincrease 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 andthen), and then index both the Social Security age and the Medicare age to life expectancy. This isa good bit faster than for Jake Pickle's reform, but the problem is also more serious. I don't likemaking 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 littlebit more flexibility for change in the future.

Jagadeesh Gokhale, November 11, 2010 [Indexing SS NRA to Lifespan: Commentary on theObama Debt Commission's Social Security Reform Proposalshttp://www.cato.org/pub_display.php?pub_id=12551

5) Index retirement ages to life expectancy: This is a long overdue reform. Social Security'sretirement ages have remained relatively fixed whereas post-retirement lifespans have increasesubstantially. This has transformed Social Security from an erstwhile retirement insurance systemto a retirement saving system, one that essentially substitutes government saving for privatesaving. But the reform does not go far enough. The proposal allows the current rate of increase inthe 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 beenaccelerated and extended until the normal retirement age reached age 72 sometime by the mid2030s. Given the considerably healthier and more active population of middle-aged and elderlytoday, this alternative policy would have made up for the long delay in increasing workinglifespans and restoring the program to its original function of providing old-age insurance.
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Changing the age requirement is consistent with the goal of privatization any system of vouchers forprivate accounts would make the age of retirement irrelevant, and eliminate an artificial incentive toretire early.

Jagadeesh Gokhale, November 11, 2010 [Indexing SS NRA to Lifespan: Commentary on theObama Debt Commission's Social Security Reform Proposalshttp://www.cato.org/pub_display.php?pub_id=12551

However, even better would be a complete elimination of early and normal retirement ages byintroducing a personal accounts system wherein the responsibility for determining one's desiredretirement living standard and generating the corresponding savings beyond a minimumtraditional Social Security benefit would reside with individual workers. The reason for this isthat statutory retirement ages together with retirement incentives prompt economically andsocially inefficient (default-driven) early retirement decisions on the one hand, and deny adequatepay-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 atransition to a post Medicare program.

John Graham, director of Health Care Studies for the Pacific Research Institute 2007[ShouldMedicare be Means-Tested? A Symposium is a nonpartisan, tax-exempt, public policy andeducational 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 taxrather than income tax creates some flattening of the otherwise harmful progressive incometax, which should itself be flat. This provides another challenge to meanstesting, because it wouldeliminate this valuable (if slight) effect and effectively increase the punitive taxation of highearners. Further, meanstesting likely worsens the malformation of private health insurancemarket, 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 ofcatastrophic out-of-pocket costs for the very small number of seniors who have huge health carecosts 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 onhealth 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-earningseniors, rich seniors would likely figure out ways around it. After all, wealthy seniors successfullygame Medicaid to finance their long-term care through asset transfersa fact known for yearsbut only recently, and marginally, addressed by last years Deficit Reduction Act. But unlikeincome, age cannot be hidden. Age-testing is more likely to succeed in solving this mess, althoughit would take a lot of groundwork to gain public acceptance. Basically, the government would tellpeople over 55 that their Medicare expectations are unchanged, while telling those under 30, forexample, to forget about receiving any benefits. People aged between those bounds would beassigned a constant, derived from a simple linear function, which would stay with them for life andwould be applied to their benefits. For example, a 50-yearold would expect 80 percent of the fullbenefits, and 40-year-old, 40 percent. Then we would freeze the actuarially determined benefitsand 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 thefact that the United States is the only country (to my knowledge) where the government orders youout of whatever health insurance you have and into a government program at age 65. That is whyboth private insurers and individuals face inadequate incentives to negotiate insurance policiesthat provide cradle to grave coverage with the optimal incentives for preventive versus curative
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care. Reforming Medicare by introducing age-testing would both save the nations fiscal housefrom burning down and gradually improve the incentives for private insurance, something thatmeans-testing, even if politically feasible, would not achieve.

Reducing Benefits

Rather than changing Who receives benefits, another set of affirmatives would change the benefitsthat 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 wouldprovide a substantial reduction in costs

Michael Tanner, Cato Institute, 2011 [Many different plans Bankrupt Entitlements and the FederaBudget 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 verydifferent impacts on recipients. The bipartisan Commission on Fiscal Responsibility and Reform,for instance, has recommended a broad array of benefit changes, including raising the retirementage to 69 by 2075, with the early retirement age rising to 64 over the same period, reforming theformula 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 ofbenefits so that they are indexed to price inflation rather than national wage growth.87 Sincewages tend to grow at a rate roughly one percentage point faster than prices, such a change wouldhold future Social Security benefits constant in real terms, but eliminate the benefit escalation thatis built into the current formula. Estimates suggest that making this change alone would result in a35 percent reduction in Social Securitys currently scheduled level of benefits, bringing the systeminto balance by 2050.88 Variations on this approach would apply the formula change only tohigher-income seniors, preserving the current wage-indexed formula for low-income seniors.89Other benefit reductions that have been discussed at one time or another include increasing thenumber 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. Allpersons who have paid into the system are currently eligible, including those with the means toprovide for themselves through private retirement accounts and health insurance. Other federal socialwelfare programs, like Medicaid and TANF, are means tested to direct the benefits to those who needthem 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 receivinga lower prescription drug benefit; thats part of what made it possible to expand the prescriptionbenefit within budgetary constraintsThe best option is probably to tie the size of Medicarebenefits to a persons lifetime income, which is relatively easily measured and hard to game, ratherthan to ones income or assets in any current year. In essence, higher earners would receive lowerbenefits instead of facing the prospect of higher taxes, as current trends predict.

Requiring Larger Premiums


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Medicare Part B requires seniors to pay premiums for gap coverage for physician services. Thepremiums that they pay cover some of the costs of the program, with the government making up therest of the shortfall. Increasing the amount that seniors would pay would reduce the governmentsspending.

Alice Rivlin, 2011 Brookings Institute [Making Medicare, Medicaid and Social SecuritySustainable 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 andreducing cost growth: authorizing Medicare to contract with accountable care organizations on thebasis of shared savings and value-based payments to providers; pilot projects to try out otherpayment reforms; research on effectiveness of treatments; and development of informationtechnology. However, the impact and timing of these efforts is still uncertain. Therefore, the TaskForce recommended several cost-saving reforms in the short run followed by a gradual transitionof Medicare to a "premium support" or defined contribution program, which would incent efficiendelivery while controlling the rate of growth of total Medicare costs. For the short-term, the TaskForce proposed these measures: Gradually raise Medicare Part B premiums from 25 to 35 percentof 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 andSocial Security. This would have the advantage of streamlining the system, and not reducing benefitsto 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 medicalprocedures that qualify for reimbursement. Managed care systems and rationing of care would help toreduce costs.

Banning Medicare or Social Security

Some Affirmatives, particularly Really Libertarian or Kritikal teams, may choose to simply phase outMedicare and/or Social Security, and claim that market alternatives will solve better withoutgovernment interference.
http://www.brookings.edu/testimony/2011/http://www.brookings.edu/testimony/2011/


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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 arehealthy 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 thisposition. 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 forserious financial troubles, and is in need of a major overhaul. The persistence of this particularbelief provides one of the most compelling examples of how politics, powerful interest groups, andpervasive 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 thenations largest anti-poverty program, with its payments keeping about half the nations elderlyabove the poverty line.. Medicare is also falsely portrayed as facing grave demographic threats toits solvency, and is currently threatened by attempts at further privatization. The myth of a

demographic timebomb has also served to shift the focus of health care reform to Medicare(thepublic sector), whereas the private sector has been the source of our most important problems Atthe same time, the myths surrounding Social Security make it difficult to apply the most valuablelessons from Americas most successful social insurance program to the problem of health carereform where they are badly needed.

The CEPR has taken the lead in compiling publications and studies to debunk the Phony Crisis. Theyclaim that demands for privatization come from deficit hawks that spread fear and claim thatdecreasing the deficit must be the countrys number one priority. This is used to avoid solutions to thetrue cause of Social Security and Medicare problems unemployment and a lack of universal healthcoverage. 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 andnot on reforming health care, spending may decrease but more middle class families will be unable toafford health care.

Robert D Feinman looks at the rhetoric surrounding the Social Security and Medicare debates andsays that most Affirmative authors are crying wolf over Medicare/Medicaid instead. This is mostlyunwarranted. [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 forMedicare and Social Security is overblown. He writes that the deficits of the programs are only onpaper, and that there is no serious funding crisis:

it seems important to debunk the hype about a Social Security crisis. There's nothing strangeor mysterious about how Social Security works: it's just a government program supported by adedicated tax on payroll earnings, . Right now the revenues from the payroll tax exceed theamount paid out in benefits. This is deliberate, the result of a payroll tax increase recommendedby none other than Alan Greenspan two decades ago. The grain of truth in claims of a SocialSecurity crisis is that this tax increase wasn't quite big enough. Projections in a recent report bythe Congressional Budget Office say that the trust fund will run out in 2052. The system won'tbecome "bankrupt" at that point; even after the trust fund is gone, Social Security revenues willcover 81 percent of the promised benefits. Still, there is a long-run financing problem. But it's aproblem of modest size. The report finds that extending the life of the trust fund into the 22ndcentury, with no change in benefits, would require additional revenues equal to only 0.54 percent


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of GDP. [The San Diego Union-Tribune The phony crisis of Social Security December 9, 2004http://www.signonsandiego.com/ uniontrib/20041209/news_lz1e9krugman.html

There is also a significant amount of solvency evidence going against the reforms mentioned in theaffirmative 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 foreach plan.

Disadvantages:

The two disadvantages that make up the core literature on the resolution are the economic impacts tocutting Social Security and Medicare, and the political reaction to it. The economic arguments revolvearound undermining the safety net for millions of American retirees, the impact that this would haveon 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 politicalbacklash that it would spark. Some of the most politically powerful lobbying groups in the US aremade 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 programshave been met with substantial resistance, such that the reforms were abandoned. While somepolitical leaders are now breaking the taboo by offering reforms, this does not mean that they will notbe controversial. During an election year, the ability to run Medicare and Social Security links wouldencourage most politics debaters.

Counterplans:

I think that the strongest strategies by the negative would revolve around counterplans that challengethe 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 aremutually exclusive approaches to reform, focusing the debate on solvency and encouraging Depth tothis debate. I think that the closest parallel is the Health Care topic, where different affirmatives werecompetitive options with each other, and became common Counterplan strategies.

The first counterplan would focus on employment and growth. One of the initial criticisms in thePhony Crisis positions is that the Social Security alarmists underestimate the levels of growth in theeconomy over the next 30-40 years. As employment rises and growth speeds up, more revenues arebrought in through payroll taxes. While this increases the committed benefits, it also provides thecapital to shore up trust funds and to pay off Treasury Securities until after the demographic shiftpeaks. The Deficit hawks are more concerned about lowering growth to head off inflation, whichnecessitates 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 thepremiums that are charged for Medicare B coverage, increasing the rate of payroll taxes, or increasingthe infusion of General Federal Revenues into the programs would head off system collapse, whileavoiding the political fallout from cutting benefits.

Another type of counterplan would look to reform Medicare or Social Security without substantiallycutting spending. Addressing fraud, waste, administrative costs, or adopting a Panel Approach toreform would potentially put off the day of reckoning for the programs.
http://www.signonsandiego.com/http://www.signonsandiego.com/


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5. Topic Criteria:

Timeliness: Politically, entitlement reform is one of the most timely issues. It is on the front burnerof the Republican agenda, is tied to the Debt Ceiling debate over the summer, and will be integral tothe 2012-2013 budget negotiations. Medicare reform legislation has been introduced in Congress, andthe 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 representedacross 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 competingproposals would challenge varsity debaters.

Quality:An entitlement reform topic would produce quality debates because the primary sources ofclash would be over solvency mechanisms, rather than harms. Those solvency mechanisms competein the literature, providing depth to the research in those debates.

Material: Medicare and Social Security have enormous amounts of research dedicated to them. Mospolicy related think tanks have entire Research Areas dedicated to entitlements, there are annualgovernment reports on the programs finances, and pending legislation has unleashed a flood ofinterest 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 (Actuarialreports make for Dense reading. I am speaking from experience), and the topic area retirementsecurity might not appeal to many debaters. I think that once researched, this becomes a Veryinteresting topic; I think debaters would be satisfied with the advantage areas and not try to avoidclash, and advanced debaters would be interested in detailed solvency debates. I think that this wouldbe 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, Evidencethe 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 onentitlements. Third Fair and Balanced - it is a Conservative topic. Most of the resolutions arewritten with a Liberal direction. This one is not. I do not know if that is Balance but it seems to befair.


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6. Why this topic:

In my limited experience writing topic papers, I am beginning to formulate a basis for what I thinkconstitutes a Good topic. I start with an initial question:Are the core cases on the topic area onesthat Affirmatives will embrace, or will they try to circumvent the topic, racing to the fringes to debateabout something that they would prefer to debate about. I think that entitlement spending wouldcapture the interest of Affirmatives, both because of the size and quality of the advantage areas, andbecause 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 constrainsthem.

I also think that it is important to debate taboo political subjects. I do not mean that we should havetopics of fringe conspiracy theories, but rather that if an important public issue is going to impact ournation in more ways than virtually any other issue, but Public Debate is Avoided or Absent on thattopic, that is regressive rather than progressive. The fact that Social Security has been the Third Railis 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 spendingthat 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 thetopic. 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 Federalspending (something states cannot fiat), but does not avoid the Politics debate. In fact, it is hard tothink 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 aredetailed 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 wherethe internal links are far-fetched.

Second there is the possibility to transform the Politics disad. Normally, I view the Politics disad asan example of everything that is bad about debate. But that doesnt mean that it has to be. A realworld quid pro quo exists between Medicare reform and the Debt Ceiling debate, and the comingBudget battle. The compromises and trades are very explicit and debatable. And the quality of the linkevidence 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.


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7. Potential Resolutions:

1. Resolved: the United States federal government should substantially reduce its Medicare and/orSocial Security spending

2. Resolved: the United States federal government should substantially reduce its spending forMedicare and/or Social Security.

3. Resolved: the United States federal government should substantially limit the growth of Medicareand/or Social Security spending.

4. Resolved: the United States federal government should substantially reduce Medicare and/orSocial Security benefits.

5. Resolved: the United States federal government should reform Medicare and/or Social Security toensure program sustainability.

6. Resolved: the United States federal government should substantially limit the growth of

entitlement spending.


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8. Wording Issues:

Privatization: I strongly think that one of the most important core affirmative plans is privatizationeither through MIRAs, MSAs, HSAs, vouchers or premium plans. This is the central thrust of theRyan proposal, and it is an important part of the Cato Institute, Heritage Foundation, Social SecurityInstitute, and Peter G. Peterson Institute proposals for reform, which make up an important part ofthe literature. Therefore, I think that the topic should be written in such a way that it encourages thisAffirmative 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 excludethis case. The plan could cut Medicare spending without requiring that the remainder is given in theform 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 adequatecoverage if the remaining benefits are spent more efficiently, which vouchers would encourage byincreasing patient choice (arguably). So forcing the Affirmative to only do the first part would hurttheir 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 fiscalsustainability. 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 orremoval of faults or abuses . There are a lot of Google hits for reform Medicare (600,000) orSocial Security reform (1,000,000), but none ofthem are definitions (Im assuming here Iobviously did not read each one), and none of them would Exclude other reforms. Reform wouldeliminate one of the strengths of the resolution the direct action that is mandated for the plan toinclude, which is pretty essential to predictably negative ground. If we used the phrases The USFGshould establish a reform to reduce Medicare spending or the USFG should reform Medicare toensure fiscal sustainability you introduce an Outcome into the resolution something that thefederal government cannot Fiat. The plan cannot Mandate sustainability, it can only Result insustainability. 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 intoEvery affirmative, but it also significantly unlimits the number and type of case the affirmative canrun.

I am convinced that people would still run privatization, and that judges would still accept it, so I amnot tremendously concerned about the Extra Topicality problem. First, there is ample precedent forthis: DADT was simply exempted into the National Service topic, Pharmaceuticals were allowed onthe Africa topic, and Futenma was accepted as topical on the Military Presence topic. While none ofthose probably met any reasonable definition of those resolutions, they were obviously reasonablycore cases, and simply allowed. Second, there is a Lot of contextual evidence saying that the Ryanproposal reduces Medicare spending. Think Progress, for the negative, says while Paul Ryans plan toeliminate 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 theRyan proposal would reduce Medicare spending by $30 billion over 10 years. Much of the savingswould be achieved by privatizing Medicare for future The GOP plan would reduce Medicaidspending by $771 billion over 10 years. [April 8, 2011]

Entitlement vs Medicare and/or Social Security: The common label given to bothMedicare and Social Security spending is Entitlement spending. A substantial amount of literaturerefers 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 asexamples of it. Entitlement spending is a term of art that is well represented in the literature. Using


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the term entitlement spending is simpler and more elegant, and provides additional room forcreative affirmatives to move beyond Social Security and Medicare. So why specify the programs inthe 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 VeteransBenefits certainly are also entitlements, and unemployment benefits are debatably entitlements.

Many conservative commentators use the term to refer to discretionary programs that have a welfarecomponent, like Food Stamps, that are probably Not entitlements, strictly speaking, but would havesubstantial 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 thevalue of additional cases.

Second Some of the additional entitlements would provide good cases like unemploymentbenefits or Medicaid cuts but some of them, like Veterans Benefits, would just be added on, likeKuwait was with the military presence topic. (Litmus Test I was not able to find a good affirmativesolvency advocate for cutting Veterans Benefits substantially.) I think that if cases are added to thetopic, 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 federallevel in the United States would include Social Security, Medicare, and Medicaid, most Veterans'Administration programs, federal employee and military retirement plans, unemploymentcompensation, food stamps, and agricultural price support programs. [A Glossary of PoliticalEconomy Terms 2005 http://www.auburn.edu/~johnspm/gloss/entitlement_program] I also thinkthat 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 fiscalstability of the programs, and their attendant impact on the federal budget. While Medicaid also facesfiscal issues, I would imagine that most of the cases for Medicaid would be about cutting a specifictype 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 therange 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 usethe term loosely to refer to the welfare state, rather than in a strict sense as a description of a type ofpolicy and benefit. I am not sure that adding that term would improve the kritikal debate so much asmake it resolutionally focused rather than on the specific affirmative. And burdening the Affirmativewith 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 wellrepresented within the literature, and many articles use both or all terms interchangeably. I do notthink that choosing one over the other would substantially impact the types of cases run or the typesof negative strategies.

Spending vs Benefits

Reduce Medicare Benefits would limit the topic significantly more than reduce Medicare spendingand 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
http://www.auburn.edu/~johnspm/gloss/entitlement_programhttp://www.auburn.edu/~johnspm/gloss/entitlement_program


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advocates, as many authors advocate reducing the size of benefits. I think that ultimately, this may beToo limited it is Overly predictable, and gives the affirmative too few mechanisms. The cases that itwould 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, tobalance predictability with adequate affirmative choices, but I think that some important cases wouldbe 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 mostauthors 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 toprevent future increases, rather than decrease it from current levels. I dont know the strategic benefitof that, and unfortunately, the literature seem to use the terms interchangeably. I understand thetechnical distinction in the types of cases allowed, and the theoretical advantages to we keep thestatus quo but I do not think that practically, it would have that much impact on what is run by theaffirmative.

Substantially

A lack of definitions, but a lot of literature. There is a significant amount of literature using thephrases substantially reduce Medicare and substantially reduce Social Security about 7,000Google hits each. Most of these are cards about whether specific proposals will substantially reducecosts, rather than definitions of how much of a reduction would be necessary in order for it to besubstantial.

A Democratic proposal to save about $100 billion by altering the procedures for purchasingpharmaceuticals was called substantial: This bill shows there are ways to substantially reduceMedicare costs without hurting beneficiaries," said Rep. Levin [Jun 17, 2011 CongressionalDocuments 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 isrequired by a law passed in 1997, but has been postponed every year since then): would cutMedicares costs very substantially over current policy The virtue of this approach is that no one hato do anything the sustainable growth rate is already in law. All our leaders have to do is promisenot 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 toreduce Medicare spending by approximately $13 billion over a 10 year period. This will notsubstantially alleviate the program's financial problems. Means-testing will not substantially reduceMedicare 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 [FederalRetirement Age] to 68 would have a much smaller impact [Urban Institute, 2010 DistributionalEffects of Alternative Social Security Reforms]

Finally, referring to a proposal from 2005 by Paul Ryan to privatize Social Security: Finally, even thesmaller accounts adopted for the first 10 years would substantially reduce Social Security's long-termdeficits [ Lawrence A. Hunter, May 12, 2005 Start the Accounts]


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9. Definitions:

Entitlement Spending ........................................................................................................................................... 24Entitlement Program ............................................................................................................................................ 25Entitlements.......................................................................................................................................................... 27Entitlement Authority ........................................................................................................................................... 28Mandatory Spending ............................................................................................................................................ 29Direct Spending .................................................................................................................................................... 30Discretionary Spending ......................................................................................................................................... 31

Welfare Spending .................................................................................................................................................. 33Social Welfare Expenditures ................................................................................................................................. 34Emergency Spending ............................................................................................................................................ 35Medicare ............................................................................................................................................................... 36Social Security ....................................................................................................................................................... 39Reform ................................................................................................................................................................... 41Medicare Reform .................................................................................................................................................. 42Social Security Reform .......................................................................................................................................... 43


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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 likeMedicare/Medicaid, Social Security, & veterans' benefits. Funding levels are automatically set by the number ofeligible recipients, not at the discretion of Congress. Each person eligible for benefits by law receives themunless Congress changes the eligibility criteria. Entitlement payments represent the largest portion of thefederal budget.


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 ofCongress. 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.


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 AbandoningThe Dormant Commerce Clause Prohibition on Discriminatory Taxation

Insofar as Professor Coenen's arguments track Professor Enrich's and the teachings of the tax expenditureschool, the replies are also the same. Tax incentives and direct subsidies need not (and often do not) take theidealized forms central to tax expenditure analysis. Tax incentives can be and are structured to be of limitedduration, 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 spendingpolicies are accepted as part of a baseline status quo which the legislature adjusts incrementally at the margins

rather than reviews from scratch.


Michael J. Graetz Professor of Law, Yale Law School. April, 1995 Columbia Law Review PAINT-BY-NUMBERSTAX 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-HollingsBudget 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 1987Amendments of Gramm-Rudman 151 and was, if anything, enhanced by the so-called pay-go requirements ofthe 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. Theamendments also required that any provisions that are estimated to lose revenue in any year of the budgetperiod must be offset by revenue-gainers of a magnitude equal to the forecasted loss. 152 This basic mechanismof the 1990 Act remains in force, but the Senate has expanded the relevant period for revenue estimates fromfive to ten years in some circumstances. 153


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Entitlement Program

Entitlement Programs

Dr. Paul M. Johnson Department of Political Science Auburn University A Glossary of Political Economy 2005http://www.auburn.edu/~johnspm/gloss/entitlement_program

Entitlement program

The kind of government program that provides individuals with personal financial benefits (or sometimesspecial government-provided goods or services) to which an indefinite (but usually rather large) number ofpotential beneficiaries have a legal right (enforceable in court, if necessary) whenever they meet eligibilityconditions that are specified by the standing law that authorizes the program. The beneficiaries of entitlementprograms are normally individual citizens or residents, but sometimes organizations such as businesscorporations, local governments, or even political parties may have similar special "entitlements" under certainprograms. 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, federalemployee and military retirement plans, unemployment compensation, food stamps, and agricultural pricesupport 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 asentitlements:

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 meetspecified eligibility requirements.3. Federal government has a legal obligation to pay that is not subject to appropriations: The payment is notdiscretionary; 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 contingenton appropriations being enacted. Therefore, if insufficient appropriations are available, the government, intheory, may be sued for payment of the benefits.

Not that although entitlements legally obligate the United States to make specified payments, funds must stillbe appropriated to cover those payments. Some entitlement programs, such as Social Security, are permanentlyappropriated and annually appropriated entitlements share the common characteristic that the cost of theprogram has been determined outside of the appropriations process through the establishment of a formuladriven program. Although annually appropriated entitlements might appear to be subject to annual fundingdecisions of the appropriations committees, in reality they are not.


Kimberly Amadeo President of WorldMoneyWatch.comhttp://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 thebudgetary process. These include Social Security, Medicare, Medicaid as well as Income Support programssuch as Food Stamps and Veterans Retirement programs. Also Known As: Direct Spending, EntitlementPrograms Examples: Mandatory spending within the U.S. budget will increase over the next ten years thanks toSocial Security expenditures for retiring Baby Boomers.


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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 ProgramA federal program that guarantees a certain level of benefits to persons or other entities who meetrequirements set by law, such as Social Security, farm price supports or unemployment benefits. It thus leavesno 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 1/23/2003http://www.gpoaccess.gov/usbudget/fy04/pdf/budget/glossary.pdf

Entitlement An entitlement program is one in which the federal government is legally obligated to makepayments or provide aid to any person who meets the legal criteria for eligibility. Examples include SocialSecurity, 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 eligibilityrequirements, 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.)


Elizabeth Garrett Assistant Professor of Law, University of Chicago. January, 1999 - Cardozo Law ReviewAccountability and Restraint: The Federal Budget Process and the Line Item Veto Act

n9. Most entitlement programs are essentially permanently appropriated; Congress enacts authority to spendmoney and the obligation to pay money arises without a periodic appropriation. Familiar entitlement programsare Medicaid, Medicare, and Social Security. Entitlement spending, which is also sometimes called mandatoryspending, is a subset of direct spending. Direct spending is any spending pursuant to a binding legal obligationto pay, including, for example, interest on the national debt. Entitlement spending is by far the largestcomponent of direct spending.


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Entitlements

Entitlement

Albany Herald April 20, 2011 [Congress definition of entitlement skewedhttp://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, butIm not sure what all should be considered entitlements. I have paid into SS for over 50 years and I consider itmine, not an entitlement. Congress is looking at raising the age of retirement to help cover their tracks ofstealing SS and spending it for their own pay raises, as well as giving to welfare recipients, which I considerentitlement. If Congress can ease the retirement age up to the expected life span, then it can effectively raisetaxes 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. Asthe name implies, entitlements tend to become politically difficult to change, as recipients come to feel entitledto what they have been receiving. Without changes, entitlements expenditure is expected to grow significantlyin the coming years. Of all the entitlements, Medicare is expected to escalate in cost the most quickly, primarilydue 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, discretionaryspending will have to be sharply reduced, or both.

Entitlement


EntitlementA Federal program or provision of law that requires payments to any person or unit of government that meetsthe eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the FederalGovernment, 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 2004http://www.democracyinaction.org/dia/organizations/chn/pdf/budgetglossary.PDF

Entitlement: Program mandating the payment of benefits to any person meeting eligibility requirementsestablished by statute. The amount spent is not controlled by annual congressional appropriations. Entitlementprograms include Social Security, Medicare and Medicaid.


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Entitlement Authority



Entitlement AuthorityA provision of law that requires payments to any person or unit of government that meets the eligibilityrequirements established by such law. Entitlements constitute a binding obligation on the part of the federalgovernment, and eligible recipients have legal recourse if the obligation is not fulfilled. Entitlement legislationrequires annual appropriations unless the existing appropriation is permanent. Examples of entitlementprograms are Social Security benefits and veterans' compensation.


AUSA Glossary Of Budget Terms Sept 29, 2005 ttp://www.ausa.org/SiteCollectionDocuments/ILW%20Web-ExclusivePubs/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 thefuture.


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Mandatory Spending

Mandatory Spending

Kimberly Amadeo President of WorldMoneyWatch.comhttp://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 thebudgetary process. These include Social Security, Medicare, Medicaid as well as Income Support programssuch as Food Stamps and Veterans Retirement programs. Also Known As: Direct Spending, EntitlementPrograms Examples: Mandatory spending within the U.S. budget will increase over the next ten years thanks toSocial 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, andMedicare. The Congressional Budget Office (CBO) estimates costs of mandatory spending programs on aregular basis. However, Congress can affect spending on entitlement programs by changing eligibilityrequirements or the structure of programs.

Mandatory Spending

Office of Management and Budget Budget of the US Government, FY 2004 1/23/2003http://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 prog rams, but they dont have totake 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 throughexisting statutory provisions without requiring the Congress and the President to enact appropriations.Entitlement programslike Social Security, crop insurance, student loans, Medicare and Medicaidareconsidered 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. Mandatoryspending 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 2004http://www.democracyinaction.org/dia/organizations/chn/pdf/budgetglossary.PDF

Mandatory Spending: Federal spending on entitlement programs and interest on the national debt. Mandatoryspending accounts for approximately two-thirds of all federal spending.


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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 AbandoningThe Dormant Commerce Clause Prohibition on Discriminatory Taxation

Insofar as Professor Coenen's arguments track Professor Enrich's and the teachings of the tax expenditureschool, the replies are also the same. Tax incentives and direct subsidies need not (and often do not) take theidealized forms central to tax expenditure analysis. Tax incentives can be and are structured to be of limitedduration, 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 spendingpolicies are accepted as part of a baseline status quo which the legislature adjusts incrementally at the marginsrather than reviews from scratch.

Direct Spending

Elizabeth Garrett Assistant Professor of Law, University of Chicago. January, 1999 - Cardozo Law ReviewAccountability and Restraint: The Federal Budget Process and the Line Item Veto Act

n9. Most entitlement programs are essentially permanently appropriated; Congress enacts authority to spendmoney and the obligation to pay money arises without a periodic appropriation. Familiar entitlement programsare Medicaid, Medicare, and Social Security. Entitlement spending, which is also sometimes called mandatoryspending, is a subset of direct spending. Direct spending is any spending pursuant to a binding legal obligationto pay, including, for example, interest on the national debt. Entitlement spending is by far the largestcomponent of direct spending.


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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 expendituresnot fixed in amount by legal oblig

Entitlement Reform

Documents

Transcript of Entitlement Reform