David Henderson’s proposal to cut Medicare spending: offer beneficiaries cash instead of a benefit in kind. I would offer everyone approved for elective surgery half the DRG rate in cash as an alternative. This is actually how some European countries handle long term care.
I am certainly not a doctor, but I would offer the following caution on the proposal about “cashing out” elective surgeries…..
namely, that some of these surgeries address conditions that could worsen if they are not addressed. The patient who takes cash may come to deeply regret their decision….and they may have no recourse at that point.
However: I was an actuarial student, and in that capacity I would contend that the Henderson proposal could be destructive. Insurance of any kind, public or private, involves the creation of a pool of money, to deal with events and conditions that no single individual can bear.
If healthy people can just take their Medicare money and waive coverage, all it will take is one event like Covid to collapse the insurance pool altogether.
Federal tax expenditures for residential real estate are around $200 billion annually, or at least they will be when the TTJA expires in 2026. The main purpose of these seems to be to incentivize the purchase of ever-larger McMansions in the exurbs, with increasingly longer commutes.
Using either carbon taxes or targeted subsidies to offset the environmental costs of existing tax policy seems a bit like driving with one foot on the brake and the other on the accelerator. Although in the case of the Inflation Reduction Act subsidies, a better analogy might be a dual-motor Tesla with the two motors being actively powered in opposite directions.