The top 1% of Medicare patients account for 20% of the total cost of Medicare. The top 5% account for 50% . This is the greatest threat to the US government finances, scarcely discussed, after the profligate funding of futile foreign wars. And now the huge Baby Boomer population is starting to have a threatening effect on the cost of Medicare, potentially blowing the budget, just as Republicans are planning to reduce taxes! Words fail me.

The high costs, to be fair, are caused by a moving population of people with serious conditions, who cost a lot for a few months,  then revert to “normal”, that is, if they don’t die in hospital. But there are some patients with chronic conditions of multiple co-occurring conditions who are treated for months. The doctors dare not end the treatment for fear of legal challenges, and relatives won’t let the sick person go. The taxpayer is stuck with the bill.

It will come as no surprise to learn that the very people who advocate spending less on the poor through Medicaid, are the biggest consumers of publically funded Medicare, ready to call a lawyer at a moment’s notice, and eager to fund research into ever longer lives for themselves – as long as they don’t have to pay for it out of their own pockets.

Surprisingly, under Republican rule, seniors will have to pay a larger share in 2018 for Medicare the richer they are (as defined by their 2016 Federal tax returns). Higher premiums will be paid for both Medicare Part B and Part D for individuals with modified adjusted gross income which exceeds $85,000.00, and married couples with joint incomes above $170,000.00. (I have tried to understand the Medicare website setting out the new arrangements, but it is written by an illiterate and, to me, it is incomprehensible. I will not try to list the new rules because you won’t probably understand them either).

The point is that there is a segment of the (well-off) population for whom no amount of public money is enough to keep them alive. Rationing is anathema for them, but reducing even basic healtthcare for the poor is apparently fine by them. It is one thing to help someone recover from acute injury, but long-term cognitive impairment should be a matter for intelligent discussion between doctors and family – keeping alheimers patients alive at all costs is cruel to everyone ( I have personal experience). End-of-life is end- of-life. If relatives want to extend it, they should make a major contribution towards the cost, not expect the taxpayer to pay out with no end in sight.

And yet…and yet…. Americans are under the illusion that American medical care is the best in the world, even though US life expectancy is lower than most other OECD countries.