How to make a fiscal cliff deal on Medicare, Medicaid and Social Security

Democrats and Republicans are deeply divided within each party as well as between parties on how to avert putting the country over the "fiscal cliff," which really is a slope, not a cliff. As a Small Government Republican Medicare beneficiary who's benefited from the free gift of Part D, cheap Medicare premiums, tax credits on home mortgages and coverage of primary care services that I should be paying for out of pocket, here's the deal I would like to see:

1. Make Medicare and Medicaid catastrophic programs only. Drop all the wellness and primary care nonsense that enriches providers and often hurts patients with false positives and harmful procedures.

2. Take all Congressionally imposed mandated benefits out of M/M.

3. Take all payments for teaching and medical research out of M/M. Fund them in separate bills and programs.

4. Breakup regional and metro hospital systems, medical groups and national health insurers.

5. Free seniors to buy non Medicare health insurance plans that cover primary care, wellness care and alternative care services without any Medicare subsidies for those premiums.

6. Raise premiums on all parts of Medicare. They're ridiculously low. 

7. Raise co-pays for all primary/preventive care and lower co/pays on catastrophically expensive cases.

8. Make Medicare Advantage enrollees pay the full premiums for the expanded coverage. 

9. Use money saved by eliminating coverage of provider-enriching preventive and wellness services to cover long-term care expenses that become catastrophically expensive as a percentage of the beneficiary's wealth, including the value of a a home or other investments. If someone is worth, say, $5 million, and long-term care costs, say, $80,000 to $100,000 a year, let that person pay for that care. If the person is worth $500,000 or less, Medicare could pay. That's the Moocher Nation way, of course.

10. Eliminate the death tax. Keep taxes on capital gains and dividends at 15%. No tax increases on the rich unless everyone gets income tax increases. Shrink the number of people who don't pay income taxes, get food stamps and are fraudulently filing disability claims.

11. Keep SS/Medicare enrollments at current ages. Change CPI calculations to reflect real inflation, which is a lot higher than the CPI shows today.

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