Look, the structure of Medicare is flawed beyond fixing. The Congress in 1965 passed a law which promises to pay, without limit, any "necessary" charges arising out of illness. This commits the Treasury every year to pay an unknown sum to cover an unknown number of charges for an unknown number of individuals.
Of course, they applied a static analysis based on voluntary transactions occurring in 1955-1964, when seniors were paying for fairly primitive services with their own money.
The promise of unrestricted Federal payments after 1965 did not produce static results, however. There was an explosion of innovation, which never would have occurred without Medicare, and resulted in (among other things) AMAZING results in joint replacement surgery, cardiovascular disease, cataracts and other visual disorders, and certain cancers.
These wonderful devices, drugs and procedures are the result of the free market, as is often correctly said. But the guarantee of customers via taxpayer dollars for payment was the rocket fuel for all this free-market creativity.
Medicare began to distort the Federal legislative and budget processes by the early 1980s. CBO predictions from 1965 using static analysis were off by a factor of 1000% by 1991.
So, the Great Compromise of 1986 was passed, to allow tax cuts together with unlimited money printing and unlimited borrowing.
These processes were essentially unchanged by 2009, with the result that Congress cannot pass a budget at all.
A crash is inevitable, and the structure of Medicare is the cause.
This was of course intentional by LBJ and his large Congressional majorities. They never saw Title XVIII (Medicare) as anything but a temporary measure on the way to nationalization. They didn't imagine it would take this long, but that's because they didn't anticipate the resilience and creativity of the US biomedical industries once they were granted unlimited taxpayer funds, or, more accurately, the ability to fund research, development, marketing and deployment with money borrowed on the full faith and credit of the United States and, when that was not enough, by borrowing against generations yet unborn.
So, death panels? My preference is for a defined benefit payment to seniors, usable only for medical services and supplementable with their own money if desired. However, this is very unlikely to happen, for the same reasons that Medicare's absurd design was invented in the first place and then allowed to continue to the point of wrecking the legislative budget process and eventually the currency.
Here is a sample:
The medical system in this country is not bankrupting people or the nation because of Obamacare. It is bankrupting people because it has managed to exempt itself from the very laws that I had to follow running an Internet company.
Those are the same laws, incidentally, that a company making cars, washing machines or for that matter computers must follow.
They are the reason that a computer today costs a tiny fraction of what a computer of equivalent capability cost a few years previous. They are the reason you can buy a $3 calculator when the original Monroe "portable" cost a few hundred dollars. They're the reason my original Sony D-5 CD player cost $350 in 1984 and yet today you can buy a CD player for $30 or less. They are the reason my first 50" HDTV cost close to $10,000, while today I can buy one at WalMart that uses a tiny fraction of the power and is also a fraction of its size and mass -- for $500.
These laws are good, not bad. They say that if you buy a laptop computer you own the ******ned thing and may do with it as you wish, including selling it to someone else for whatever price you may negotiate between you.
They also say that if I, as a manufacturer of said computer, get together in a room with other manufacturers and try to fix prices we all go to prison because that's a violation of 15 USC, the Sherman and Clayton Acts. We can go to prison for a decade and be fined $1 million each, while our respective companies can be fined $100 million -- for each attempt.
These two laws say that any act designed to fix prices or restrain trade by agreement or conspiracy between two or more entities where market power exists is per-se unlawful and triggers these penalties.
This is a good law. It is a law that I lived by despite having one hundred competitors in my local market. I lived by it not only because it was the law but because competition is good and it results in better goods and services, along with lower prices, for everyone. Those who put forward a superior product at a lower price prosper, those who can't or don't fail. That's what competition is and there is exactly none of it in the medical industry.