Dear Paul Ryan

I know you want to reduce Medicare spending.  In our current Medicare system,  5% of Medicare recipients use 30% of Medicare’s $540 billion annual resources during their last year of life. This means 2.25 million people spend $79,956 each for a year of measures that increase longevity, but may decrease quality of life.  Some people want this; many do not.

I’ve been thinking about this and I want to help.  I’ve developed a proposal to drastically  reduce Medicare costs, create new jobs and make people happy—a politician’s dream.

My proposal? Eliminate the last year of life.

Oncologist and bioethicist Zeke Emanuel wrote an article for the Atlantic explaining that “longevity without vitality is overrated.”  Based on his experience with the elderly, he wants to die by age 75.  Using his idea, I suggest adding an optional Medicare Part74XIT to original Medicare.  Under this plan, seniors could opt out of extreme medical measures, save Medicare gobs of money and enjoy a wonderful final year while they are still in relative good shape.

“What would be their incentive to do this,” you ask, “and how might it be carried out?”  A good question.

First, opting for Part 74XIT requires that the person die by age 75.  Most people don’t really want to commit suicide, but many would be willing to pass over at age 74 under the right circumstances and if somebody else took responsibility.  Given that, here are several choices.

1.  Hire a hitman/hitperson to do the job.  According to Google, the average hit costs about $5000.  If the Federal government provided this service, it would probably cost more, so rather than doing the actual hit, Medicare.gov would provide a link to a list of qualified hit providers, and the IRS would designate the cost of a hit a deductible expense on schedule A.  Indeed, a person’s RMD could be used for this expense and be deducted!  For those who don’t have $5000, it could be covered by Title LXXIV (needs a bill sponsor).  Medicare beneficiaries can chose to have this hit a surprise or they can schedule it at their convenience no later than the eve of their 75^th birthday.  Not only does this create new jobs (felons welcome to apply), perhaps even a new industry, but it should satisfy the NRA and 2^nd amendment paranoiacs and nut jobs. Note: The number of jobs created will depend upon the number of Medicare beneficiaries choosing this option.  I’m sure Gallup can come up with a ballpark estimate.  Cost $5,000.
2. An alternative option for the squeamish could be a professionally-assisted transition, with the cost of  medication covered by Medicare. This option will create new jobs as  the funeral industry adds the professional Blast Off Party option to their list of services.  Total cost: $5000 ($3000 for the medication–unbelievable, huh,$1000 for the professional, and $1000 for the party).

While there may be a few who are willing to select Plan 74XIT to save money for their country, there must be an incentive for the other ambivalent multitudes.  Here are the bonus perks for those who opt in.

1. Starting on the 1^st day of the month of the beneficiary’s 74^th birthday, s/he will receive a $100 gift card every month to be used at a restaurant (it can be used at a different restaurant each month and covers food, alcohol and gratuity up to the $100). Increased jobs in the restaurant industry. Cost $1200
2. Each beneficiary will receive two round-trip business class tickets to a foreign destination not to exceed $10,000 total. This allows the beneficiary and guest (not including children who encouraged the parent to choose this option) to travel in comfort to a really nice river cruise someplace.  Many beneficiaries will now have the funds to purchase the river cruise because they don’t have to save all their money until an indefinite age. If the tickets cost less than $10,000 the excess can go to the cost of the cruise.  Should a person choose the domestic option instead, they can use the $10,000 to cover travel expenses for a couple of Road Scholar trips in the United States.  This will increase jobs in the travel industry and boost air travel profits.  Cost $10,000. 

The cost of this incentive proposal is $16,200 per person ($5000 hit + $1200 gift card + $10,000 travel.   This saves the government $63,752 annually per beneficiary ($79,956-$16,200).  This Plan is limited to age 74 because lots of people will die before then anyway thus limiting the universe of participants.

According to statistics, 13,061,122 Americans reach their 75^th birthday alive.  If 10% of those choose Part 74XIT, that means 1,306,112 will opt to die when they are 74.  This translates into a direct Medicare reduction of $83.3 billion the first year (give or take a few million for those who get sick and use the extreme measures the first year).  This direct savings does not take into account the additional Medicare savings accrued during the subsequent years for those who didn’t reach their 75th birthday.  Huge!

I’m confident after seeing what a great time their 74-year-old friends and relatives are having on Uncle Sam’s tab, a higher percentage of seniors will sign up for Part 74XIT in the following years

Of course there are a few details to be worked out, like what if someone changes their mind.  They can do so and the costs of their bonus perks will be added to their taxes.  A few people may take their business-class tickets and not return.  Well that then becomes the problem of the destination country.  We can figure out how to deal with it if and when the escaped senior is returned.

So Paul, what do you think?  I bet you don’t get many ideas that save $83.3 billion plus create jobs (not including the additional billable hours for the legal profession), increase spending for travel and probably tobacco, plus make all the annuity and private medical insurance companies happy.  Not a bad idea huh?  It’s a variation on the Obamacare Death Panels that the GOP so unkindly mocked and destroyed.  Kinda shot yourself in the foot with that one, no?

I hope you’ll take this proposal under consideration.  Let me know how I can be of further  help.   I’d like to see this in place by 2021 because that’s the year I turn 74 and I really like business class.

Your welcome,

Elizabeth

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