Some obese Americans on Medicare and Medicaid could get access to expensive weight loss drugs under a five-year experiment being planned by the Trump administration.

Under the proposed plan, state Medicaid programs and Medicare Part D insurance plans will be able to voluntarily choose to cover Ozempic, Wegovy, Mounjaro and Zepbound for patients for “weight management” purposes, according to Centers for Medicare and Medicaid Services documents obtained by The Washington Post.

It’s a strong signal that the administration is open to more broadly covering GLP-1 drugs — lauded by many as a miracle solution to Americans’ long-standing struggle with weight — through government insurance programs. Medicare covers the drugs mainly for patients with Type 2 diabetes, even as some private insurance plans cover them for patients with obesity.

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Medicare, Medicaid Plans To Experiment With Covering Weight Loss Drugs – @washingtonpost https://t.co/ctAu2B9pX5

— LiveSquawk (@LiveSquawk) August 1, 2025

For decades, the prices Medicare pays doctors for different medical services have been largely decided not by Medicare itself, but by a powerful industry group, the American Medical Association.

An A.M.A. committee meets in secret to determine the difficulty and time demands of each type of medical visit, test and procedure, and then recommends to Medicare how much doctors should be paid for performing them.

And for decades, critics have complained that this process unfairly rewards surgeons and other specialists, at the expense of primary care physicians and other generalists.

Medicare officials have been loath to change it because it has spared them from needing their own staff and budget to make such pricing decisions, along with the unpleasant politics of adjudicating conflicts between competing groups of physicians.

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“Under the new proposal, Medicare would pay 2.5 % less for every procedure, operation & medical test in 2026, based on data suggesting there have been improvements in “efficiency” over the years.”https://t.co/vZDu3kwjC4

— Howard Liu, MD MBA (@DrHowardLiu) July 21, 2025

…the One Big Beautiful Bill act (BBB) that passed the Senate on July 1st and the House on July 3rd looks more like traditional tax-cutting, spending-slashing Republicanism worthy of Paul Ryan or Mitt Romney than it does a MAGA fantasy. Suddenly, business leaders are again willing to see Mr Trump as the populist from his first term: a man to be taken seriously but not literally.

Unfortunately, the BBB, which Mr Trump plans to sign into law on July 4th, is likely to cast a shadow over this sunny picture. It illustrates the long-term damage Mr Trump is doing to the foundations of America’s economy.

The bill’s main effect is to extend the tax cuts from Mr Trump’s first term which were due to expire. Republicans paint this as an extension of the status quo. Yet they, like the Democrats before them, ignore the fact that the status quo is unsustainable. Over the past 12 months America’s budget deficit has been an astonishing 6.7% of GDP. If the bill passes, the deficit will remain around that level and the country’s debt-to-gdp ratio will in about two years exceed the 106% reached after the second world war. Revenue from tariffs will help, but not enough to stop the ratio rising—meaning that the drift towards crisis will continue.

To the extent the bill tightens the belt, it does so in the wrong places. As life expectancies rise and the population ages, America should trim handouts to the old, for example by raising the retirement age. Instead, pensioners are getting a tax break and Republicans are cutting Medicaid, health insurance for the hard-up. Some sensible measures include reducing the ability of states to game the system for more federal cash. Yet according to official projections, the overall effect will be to add nearly 12m to the number of Americans without health insurance. That is a scandalous number for the world’s richest big country. Many of those who lose coverage will fall foul of new requirements that recipients must work. Such rules have in the past created an obstacle course of paperwork for claimants while failing to boost employment.

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The panic about tariffs has given way to cautious optimism. But Trumponomics 2.0 will erode the foundations of America’s prosperity https://t.co/d7Z1uq4Eca pic.twitter.com/raYf0JGOOv

— The Economist (@TheEconomist) July 3, 2025

Payments from government entitlement programs — transfer payments — are the fastest-growing major component of citizens’ personal income. Such transfers are the third-largest source of personal income: In 2022, the average citizen received almost as much from government transfers ($11,500) as from investments ($12,900), and more than one-quarter as much money as was obtained from work. This average citizen received six times more (adjusted for inflation) in government transfer payments than in 1970, during which span income from other sources increased less than half as much. Transfers’ share of total (inflation-adjusted) personal income has more than doubled since 1970, from 8.2 percent to 17.6 percent in 2022.

The Washington-based Economic Innovation Group, which promotes economic dynamism, has released a report, “The Great ‘Transfer’-mation,” explaining how swiftly U.S. communities became dependent on government transfer payments. In 2022, Americans received $3.8 trillion in government transfers, 18 percent of all personal income. In 1970, not even 1 percent of counties received one-quarter or more of personal income from transfers. By 2000, 10 percent did; in 2022, it was 53 percent. This is certain to increase as the population ages.

The primary explanation: the aging U.S. population.

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https://t.co/O2tuE8fr4b
A mountain of government payments buries the myth of American self-reliance

— The Good Shepherd (@HoyasFan07) October 30, 2024

Private Medicare insurers got about $4.2 billion in extra federal payments in 2023 for diagnoses from home visits the companies initiated, even though they led to no treatment, a new inspector general’s report says.

The extra payments were triggered by diagnoses documented based on the visits, including potentially inaccurate ones, for which patients received no other medical services, the report says. Insurers offering private plans under Medicare, known as Medicare Advantage, are paid more when patients have costly conditions.

Each visit was worth $1,869 on average to the insurers, according to the Office of Inspector General for the Department of Health and Human Services. The findings are similar to those of a Wall Street Journal investigation published in August. It showed that insurers between 2019 and 2021 pocketed an average of $1,818 for each visit based on diagnoses for which people received no other treatment.

The OIG recommended in Thursday’s report for the first time that Medicare restrict or even cut off payments for diagnoses from these visits. 

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It is official now that the @HHSOIG has determined that #MedicareAdvantage health plans w/ @UHC leading the way received over $4B in diagnosis upcoding from home visits. Medicare Paid Insurers Billions for Questionable Home Diagnoses, Watchdog Finds https://t.co/OO1R4Alcwk

— Ed Gaines (@EdGainesIII) October 24, 2024

The Congressional Budget Office (CBO)…[recently] released new ten-year budget and economic projections – an update from its February baseline – again confirming that the national debt is on an unsustainable path. According to CBO’s new projections:

Debt held by the public will reach a new record by the end of Fiscal Year (FY) 2027 – 106.2 percent of GDP – and rise to 122.4 percent of GDP by the end of 2034.

The budget deficit will rise to $1.9 trillion (6.7 percent of GDP) in FY 2024 and $2.9 trillion (6.9 percent of GDP) by 2034, totaling $22.1 trillion over the 2025-2034 budget window.

Interest costs will reach a near-record 3.1 percent of GDP this year – exceeding defense and Medicare spending – set a new record next year and grow to 4.1 percent of GDP by FY 2034.

Under CBO’s latest baseline, federal debt held by the public will grow by $23 trillion through FY 2034, from over $27 trillion today to nearly $51 trillion by the end of 2034. As a share of the economy, debt will rise from 97.3 percent of Gross Domestic Product (GDP) at the end of 2023 to 106.2 percent by 2027 – surpassing the prior record set just after World War II – and 122.4 percent of GDP by 2034. Debt in 2034 will be $2.4 trillion and 6.4 percent of GDP higher than projected in February.

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📈 In its latest budget and economic projections released today, @USCBO again confirmed that the national debt is on an unsustainable path:

➤ Debt held by the public will reach a new record by the end of FY 2027, rising to 122.4% of GDP by the end of 2034.

➤ The budget… pic.twitter.com/22RnFOTbDh

— CRFB.org (@BudgetHawks) June 18, 2024

The Social Security and Medicare Trustees just released their annual reports on the financial status of the Social Security and Medicare programs. The Trustees project that both the Social Security and Medicare trust funds are within 12 years of insolvency and in need of trust fund solutions. Specifically, they project the Social Security Old Age and Survivors Insurance (OASI) trust fund will run out of reserves in 2033, the Medicare Hospital Insurance (HI) trust fund will become insolvent by 2036, and the Social Security Disability Insurance (SSDI) trust fund will remain solvent over the 75-year projection window. Assuming revenue is reallocated in the years between OASI and SSDI insolvency, the theoretically combined Social Security trust funds will be insolvent by 2035.

In other words, Social Security’s retirement trust fund will reach insolvency when today’s 58-year-olds reach the normal retirement age and today’s youngest retirees turn 71. At that point, all beneficiaries will face a 21 percent across-the-board benefit cut. On theoretically combined basis, all beneficiaries will face a 17 percent cut in 2035. Over the full 75-year projection window, Social Security’s combined funds faces an actuarial imbalance of 3.50 percent of taxable payroll, which is the equivalent of 1.2 percent of Gross Domestic Product (GDP) or 20 percent of all future benefits.

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🚨 ANALYSIS: The latest #Medicare Trustees' projections show:

➤ The HI Trust Fund will run out of reserves in 12 years, and faces a large shortfall;
➤ Total Medicare costs will grow rapidly;
➤ Medicare's outlook has largely improved since last year, but might be far worse… pic.twitter.com/G7fyrvCILX

— CRFB.org (@BudgetHawks) May 7, 2024

Spending on safety net programs such as Social Security and Medicare continues to grow even as their trust funds face the prospect of being depleted in the next 10 years.

“Also boosting deficits are two underlying trends: the aging of the population and growth in federal health care costs per beneficiary,” Mr. Swagel said. “Those trends put upward pressure on mandatory spending.”

The national debt is likely to be even larger than the budget office is predicting, as its forecast assumes that the 2017 tax cuts that Republicans enacted will fully expire even though lawmakers are already considering extending many of the measures, including lower individual income tax brackets.

For the second time in less than a year, the budget office said it now expected Mr. Biden’s efforts to wean the nation from fossil fuels to be more popular with the public — and more expensive for taxpayers — than initially estimated.

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New: U.S. Debt on Pace to Top $54 Trillion Over Next 10 Years w/ @jimtankersley https://t.co/VZ9wDWn5l2

— Alan Rappeport (@arappeport) February 7, 2024

Black Swan author Nassim Nicholas Taleb said the US deficit is swelling to a point that it would take a miracle to reverse the damage.

“So long as you have Congress keep extending the debt limit and doing deals because they’re afraid of the consequences of doing the right thing, that’s the political structure of the political system, eventually you’re going to have a debt spiral,” he said Monday night at an event for Universa Investments, the hedge fund firm he advises. “And a debt spiral is like a death spiral.”

Taleb defined the ballooning debt load as a “white swan,” a risk that’s more probable than a surprise “black swan” event. While he didn’t identify specific outcomes in markets, he did say white swans include both the US deficit and an economy that’s far more vulnerable to shocks than in prior years.

The reason for that, he said, is that the world is far more interconnected due to globalization, with issues in one region able to ricochet around the world.

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Black Swan author Nassim Nicholas Taleb says as long as you have a government continually extending the debt limit and doing deals because they're afraid of the consequences of doing the right thing, then eventually you're going to have a debt spiral. https://t.co/pQFrtVNqus

— Ben Woodward, CFA (@BennettWoodman) January 31, 2024

In a year when the US economy exceeded almost everybody’s expectations, the underlying federal deficit roughly doubled, spotlighting a dire fiscal trajectory likely to only worsen the partisan budget battles in Washington.

The government ran a $2.02 trillion deficit for the fiscal year through September, after adjustments to remove the impact of President Joe Biden’s student-loan forgiveness program, which was scotched by the Supreme Court. The gap is $1.02 trillion more than the prior year.

The surge is a powerful illustration of a fiscal path that’s triggered warnings from economists, politicians and credit rating agencies. It also helps explain why yields on longer-term US Treasuries are reaching highs unseen since before the global financial crisis, with the government needing to issue ever more debt to cover the shortfall of revenues relative to spending. Ten-year yields surpassed 5% on Monday.

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The US government had a $2 trillion budget deficit for the fiscal year through September, a gap that's $1 trillion more than the prior year. https://t.co/M69cTCs6Yl pic.twitter.com/LMOoK3Nxen

— Lisa Abramowicz (@lisaabramowicz1) October 24, 2023

When it comes to the size of the federal government’s annual deficit, appearances can be deceiving.

The gap between spending and revenue for fiscal year 2023, which ended on Sept. 30, was $1.7 trillion, the Congressional Budget Office projected ahead of the official Treasury Department figures. That would be a roughly $300 billion widening in the shortfall from fiscal year 2022.

But the gap was actually much larger. That is because of the odd way President Biden’s attempt to broadly cancel student debt shows up in budget figures.

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The Federal Deficit Is Even Bigger Than It Looks: Student-debt cancellation complicates the numbers as higher interest rates make borrowing costlier https://t.co/UnnEwiCbb6 pic.twitter.com/WqwpDVfUfn

— Jesse Felder (@jessefelder) October 13, 2023

But the biggest consequences will be for the biggest borrower — namely the US government. As Greg Ip put it in Thursday’s Wall Street Journal, “Rising Interest Rates Mean Deficits Finally Matter.” It is no coincidence, he argued, that “the recent rise in bond yields came as Fitch Ratings downgraded its US credit rating, Treasury upped the size of its bond auctions, analysts began revising upward this year’s federal deficit, and Congress nearly shut down parts of the government over a failure to pass spending bills.”

US fiscal policy has long been on an unsustainable trajectory — for more than 20 years, in fact. But under President Joe Biden it has jumped the shark. The federal deficit looks like it will exceed 7% of GDP in fiscal 2023, after the Congressional Budget Office adjusts for the vagaries of policy on student debt forgiveness. That is a truly shocking number for an economy that is running at close to full employment. And, as I pointed out here a month ago, there is no scenario the CBO can devise in which the total debt relative to GDP does not keep growing, with spending driven up partly by the rising burden of interest payments.

The key problem, as Brian Riedl of the Manhattan Institute has pointed out, is that the average maturity of the federal debt is just 76 months. So even if the CBO is right, and long-term interest rates average 4% over the next three decades, the result will still be budget deficits rising to 10% of GDP. And each additional percentage point on interest rates would add an additional $2.8 trillion of debt service costs over 10 years.

This disastrous outcome is a perfect illustration of the law of unintended consequences.

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“In terms of total returns, this is the biggest bond market rout in 150 years.”https://t.co/ufQO76ioX6 via @opinion

— Bruce Mehlman (@bpmehlman) October 10, 2023

It is sobering to think that the US federal government was running a large budget surplus in 2000 and the gross debt ratio was 54pc of GDP.

A quarter of a century later the ratio is 120pc and vaulting past the 1945 peak. This is partly due to two big recessions and Covid, to be sure, but mostly due to three sets of unfunded tax cuts, two unfunded 21st-century wars and no serious effort to control ballooning middle-class entitlements.

David Kelly from JP Morgan says the US is looking at annual fiscal deficits of $2 trillion this year, next year, and as far as the eye can see. This is at a time of effectively full employment and what should be bumper tax revenues. The deficit could hit $3.5 trillion in the next downturn.

The US Treasury must roll over $8 trillion of existing debt and raise $2 trillion of fresh debt this fiscal year, even as the Fed tosses another $1 trillion onto the heap under its QT programme.

Investors have belatedly, and suddenly, woken up to the shocking implications of a structural budget deficit heading for 8pc of GDP even before any trouble starts. It is this that has driven up yields on US Treasuries by 100 basis points since July.

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If rates continue to rise the way that they’ve been rising, eventually there’s going to be a financial accident, eventually something will break, said JP Morgan’s David Lebovitz on Bloomberg Surveillance. https://t.co/ZsQ8NfcD3n must-read. we thank AEP & David Lebovitz @jpmorgan

— tom keene (@tomkeene) October 7, 2023

The unexpected deficit surge, which comes amid signs of strong growth in the economy overall, is likely to shape a fierce debate on Capitol Hill about the nation’s fiscal policies as lawmakers face a potential government shutdown this fall and choices over trillions of dollars in expiring tax cuts. The Senate will return this week from August recess, and the House will be back the following week. Biden and House Speaker Kevin McCarthy (R-Calif.) approved a deal in June to raise the nation’s borrowing limit, but it did little to alter the long-term debt trajectory.

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🇺🇸 U.S. deficit explodes even as economy grows – Washington Posthttps://t.co/IAXBFZ66WK pic.twitter.com/AEnOvk8hVP

— Christophe Barraud🛢🐳 (@C_Barraud) September 4, 2023

President Biden scored an early political point this month in his fight with congressional Republicans over taxes, spending and raising the federal debt limit: He forced Republican leaders to profess, repeatedly, that they will not seek cuts to Social Security and Medicare.

In the process, Mr. Biden has effectively steered a debate about fiscal responsibility away from two cherished safety-net programs for seniors, just as those plans are poised for a decade of rapid spending growth.

New forecasts from the nonpartisan Congressional Budget Office, released on Wednesday, showed Medicare and Social Security spending growth rapidly outpacing the growth in federal tax revenues over the next 10 years. That is the product of a wave of baby boomers reaching retirement age and beginning to tap the programs, which provide guaranteed income and health insurance from the time benefits are claimed until death.

Those retirees are an electoral force. In refusing to touch so-called entitlement programs, Mr. Biden was appealing to seniors, along with generations of future retirees, when he used his State of the Union address and subsequent speeches this month to amplify attacks on Republican plans to reduce future spending on Social Security and Medicare or potentially sunset the programs entirely.

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A healthy country would tackle this program head on and make the necessary adjustments and compromises to do so 4/4 https://t.co/bjLzztGF23 #socialsecurity #medicare #unfundedliabilities #usa #Stewardship all we are doing now is making things worse for those who come after us

— Kendall Harmon (@KendallHarmon6) February 16, 2023

The federal government’s debt has risen from less than 40% of GDP a decade ago to 78% now, and the Congressional Budget Office (CBO) predicts that the ratio will rise to 96% in 2028. Because foreign investors hold the majority of US government debt, this projection implies that they will absorb more than $6 trillion in US bonds during the next ten years. Long-term interest rates on US debt will have to rise substantially to induce domestic and foreign investors alike to hold this very large increase.

Why is this happening? Had last year’s tax legislation not been enacted, the 2028 debt ratio would still reach 93% of GDP, according to the CBO. So the cause of the exploding debt lies elsewhere.

The primary drivers of the deficit increase over the next decade are the higher cost of benefits for middle-class older individuals. More specifically, spending on Social Security retirement benefits is predicted to rise from 4.9% of GDP to 6%. Government spending on health care for the aged in the Medicare program – which, like Social Security, is not means tested – will rise from 3.5% of GDP to 5.1%. So these two programs will raise the annual deficit by 2.7% of GDP.

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The U.S. debt burden may soon be in the same league as that of Italy, Greece, & Portugal, with or without the recently-passed tax cuts. https://t.co/CpwIFWux94

— Paul Banura (@pbanura) May 29, 2018

A picture with SO many implications…. #economy #politics #demographics #babyboomers #entitlements #budget #generationalconflict pic.twitter.com/zOhjr9BFWN

— Kendall Harmon (@KendallHarmon6) October 12, 2017

Mr. [John] Cogan has just written a riveting, massive book, “The High Cost of Good Intentions,” on the history of entitlements in the U.S., and he describes how in 1972 the Senate “attached an across-the-board, permanent increase of 20% in Social Security benefits to a must-pass bill” on the debt ceiling. President Nixon grumbled loudly but signed it into law. In October, a month before his re-election, “Nixon reversed course and availed himself of an opportunity to take credit for the increase,” Mr. Cogan says. “When checks went out to some 28 million recipients, they were accompanied by a letter that said that the increase was ‘signed into law by President Richard Nixon.’ ”

The Nixon episode shows, says Mr. Cogan, that entitlements have been the main cause of America’s rising national debt since the early 1970s. Mr. Trump’s pact with the Democrats is part of a pattern: “The debt ceiling has to be raised this year because elected representatives have again failed to take action to control entitlement spending.”

A faculty member at Stanford’s Public Policy Program and a fellow at the university’s Hoover Institution, Mr. Cogan, 70, is one of those old-fangled American men who are always inclined to play down their achievements. The latest of his is the book that draws us together in conversation. To be published later this month by Stanford University Press, it is a 400-page account of how federal entitlement programs evolved across two centuries “and the common forces that have been at work in causing their expansion.”

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Yes, this country can handle the nearly $600 billion federal deficit estimated for 2016. But the deficit has grown sharply this year, and will keep the national debt at about 75 percent of the gross domestic product, a ratio not seen since 1950, after the budget ballooned during World War II.

Long-term, that continued growth, driven by our tax and spending policies, will create the most significant fiscal challenge facing our country. The widely respected Congressional Budget Office has estimated that by midcentury our debt will rise to 140 percent of G.D.P., far above that in any previous era, even in times of war.

Unfortunately, despite a brief discussion during the final presidential debate, neither candidate has put forward a convincing plan to restrain the growth of the national debt in the decades to come.

Read it all. For a very important background on this, please see this 2011 post and the comments thereon, in which Boston University’s Laurence J. Kotlikoff makes clear that the true figure of our actual indebtedness is in excess of 200 Trillion dollars–KSH.

But much more important is the steep upward trajectory of our long-term debt ”“ which remains as dangerous as ever. In its latest long-term outlook, released in June, CBO projected that the federal debt will climb to 141 percent of GDP by 2046 ”“ by far the highest level on record.

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The panel, which included doctors, nurses, insurers, religious leaders, lawyers and experts on aging, said Medicare and other insurers should create financial incentives for health care providers to have continuing conversations with patients on advance care planning, possibly starting as early as major teenage milestones like getting a driver’s license or going to college.

It called for a “major reorientation and restructuring of Medicare, Medicaid and other health care delivery programs” and the elimination of “perverse financial incentives” that encourage expensive hospital procedures when growing numbers of very sick and very old patients want low-tech services like home health care and pain management.

And it said that medical schools and groups that accredit and regulate health providers should greatly increase training in palliative care and set standards so that more clinicians know how to compassionately and effectively treat patients who want to be made comfortable but avoid extensive medical procedures.

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When 83-year-old Maybell Prewette spent one night in an Eden, N.C., hospital a few years ago because she felt dizzy, she was stunned to find out that a couple puffs of allergy nasal spray cost her more than $600.

Medicare didn’t cover the prescription because Prewette was never admitted as a patient at the hospital.

Instead, she was kept overnight for observation. The federal Medicare program doesn’t cover the cost of drugs self-administered by “observation status” patients.

Prewette called her local pharmacy after she was discharged and discovered it charges $30 for the same nasal spray. The hospital marked the medicine up 2,000 percent.

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In the first large-scale study to directly measure wasteful spending in Medicare, researchers found that Medicare spent $1.9 billion in 2009 for patients to receive any of 26 tests and procedures that have been shown by empirical studies to offer little or no health benefit.

By analyzing Medicare claims data, researchers in the Harvard Medical School Department of Health Care Policy found that at least one in four Medicare recipients received one or more of these services in 2009. What’s more, those 26 services are just a small sample of the hundreds of services that are known to provide little or no medical value to patients in many circumstances.

“We suspect this is just the tip of the iceberg,” said study author J. Michael McWilliams, associate professor of health care policy. The study appears today in JAMA Internal Medicine.

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We start with this reality: Social Security and Medicare are practically sacrosanct. Nearly nine-in-ten Americans say they’re good for the country. That’s an amazing number. But the popularity of these programs really isn’t all that surprising. People love them because they do what they were created to do. They ease many of the frets and dreads of old age ”“ a blessing not just for seniors but for everyone who loves, supports and depends on seniors. Which is to say, everyone.

But the status quo is unsustainable. Some 10,000 Baby Boomers will be going on Social Security and Medicare every single day between now and 2030. By the time everyone in this big pig-in-the-python generation is drawing benefits, we’ll have just two workers per beneficiary ”“ down from three-to-one now, five-to-one in 1960 and more than forty-to-one in 1945, shortly after Social Security first started supporting beneficiaries.

The math of the 20th century simply won’t work in the 21st. Today’s young are paying taxes to support a level of benefits for today’s old that they have no realistic chance of receiving when they become old. And they know it ”“ just 6% of Millennials say they expect to receive full benefits from Social Security when they retire. Fully half believe they’ll get nothing.

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Treasury Secretary Jacob J. Lew warned Congress on Wednesday that the government would most likely exhaust its ability to borrow in late February, setting up yet another fiscal showdown with Republicans, and this time earlier than congressional leaders had anticipated.

In a letter to Speaker John A. Boehner and the other top three congressional leaders, Mr. Lew said a surge of February spending, mainly tax refunds for 2013, would leave the Treasury with little room to maneuver after the official debt limit is reached on Feb. 7.

The letter amounts to an early alarm bell, coming just weeks after Congress passed its first bipartisan budget and comprehensive spending bill in years. Those bills were supposed to serve as a cease-fire in the budget wars that have rattled the country and the economy since Republicans took control of the House in 2011.

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True to their “live to work” reputation, some baby boomers are digging in their heels at the workplace as they approach the traditional retirement age of 65. While the average age at which U.S. retirees say they retired has risen steadily from 57 to 61 in the past two decades, boomers — the youngest of whom will turn 50 this year — will likely extend it even further. Nearly half (49%) of boomers still working say they don’t expect to retire until they are 66 or older, including one in 10 who predict they will never retire.

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While plenty of baby boomers, born from 1946 to 1964, have become affluent and many elderly around the U.S. face financial hardship, the wealth disparity of this father and daughter is emblematic of a broad shift occurring around the country. A rising tide of graying baby boomers is less secure financially and has a lower standard of living than their aged parents.

The median net worth for U.S. households headed by boomers aged 55 to 64 was almost 8 percent lower, at $143,964, than those 75 and older in 2011, according to Census Bureau data. Boomers lost more than other groups in the stock market and housing bust of 2008, and many also lost their jobs in the aftermath at a critical point in their productive years.

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But there’s a problem. [Charles] Lindblom’s common-sense insight has a giant exception: crises. Change, forced by outside events, then happens by “leaps and bounds.” The recent financial crisis caused Congress and two presidents to embrace measures (the rescue of big banks, General Motors and Chrysler) that were unthinkable a few months earlier. In the 1960s, civil rights demonstrations pushed Congress to pass the Civil Rights Act of 1964 that, in outlawing most public racial discrimination, wasn’t “incremental.” History offers other examples, including the Civil War, the New Deal and both World Wars. Small changes won’t suffice when big changes are required.

On the budget, muddling through comes with a crucial assumption. It is that continuous deficits won’t provoke a crisis that compels political leaders to take harsh steps that they would otherwise not take. This optimism may be justified. For decades, “experts” have warned of the dire consequences of unchecked deficits. Yet no great crisis has occurred. But this conviction also could be complacency. Government debt is in territory that, except for wartime debt, is unprecedented. We don’t know the consequences. Someday, we may no longer have the luxury of muddling through.

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No one wants to be against Grandma, who ”” as portrayed in the media ”” is kindly, often suffering from some condition, usually financially precarious and somehow needy. But projecting this sympathetic portrait onto the entire 65-plus population is an exercise in make-believe and, frequently, political propaganda. The St. Louis Fed study refutes the stereotype. Examining different age groups, it found that since the financial crisis, incomes have risen for the elderly while they’ve dropped for the young and middle-aged.

The numbers are instructive. From 2007, the year before the financial crisis, to 2010, median income for the families under 40 dropped 12.4 percent to $39,644. For the middle-aged from 40 to 61, the comparable decline was 11.9 percent to $56,924. Meanwhile, those aged 62 to 69 gained 12.3 percent to $50,825. For Americans 70-plus, the increase was 15.6 percent to $31,512. (All figures adjust for inflation and are in 2010 “constant” dollars. The “median income” is the midpoint of incomes and is often considered “typical.”)

There has been a historic shift in favor of today’s elderly. To put this in perspective, recall that many family expenses drop with age. Mortgages are paid off; work costs vanish; children leave. Recall also that incomes typically follow a “life cycle”: They start low in workers’ 20s, peak in their 50s, and then decline in retirement, as wages give way to government transfers and savings. Against these realities, the long-term gains of the elderly and losses of the young are astonishing. From 1989 to 2010, median income increased 60 percent for those aged 62 to 69 while falling 6”‰percent for those under 40 and 2”‰percent for those 40 to 61.

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1–A constant battle is underway between insurance companies that do not want to pay any claims, even legitimate ones, and doctors and hospitals incentivised to rip off patients, insurers, and taxpayers with unnecessary surgeries and Medicare fraud.

2–Insurance companies demand massive amounts of paperwork out of rational fear of fraud and unnecessary treatments. Doctors perform for-profit (as opposed to for-patient) procedures that guarantee more explanations and more paperwork.

3–Doctors and hospitals have direct personal contact with patients, but insurance companies don’t. In cases where doctors put patients at huge risk with needless procedures and surgeries, it’s easy for hospitals and doctors to point their finger at insurance companies. On the other hand, many sincere, honest doctors have difficulty getting patients the care they should have because insurers believe they are getting ripped off by unnecessary procedures, even when they aren’t….

Read it all.