Just by way of starting a meaningful discussion:
Contrary to propaganda, the Social Security System actually is not in deep trouble - some rather minor tweaks to the funding mechanism can make SS secure way into the future. Medicare however is a different story. The growth in Medicare spending is at a rate that truly is not sustainable over the long haul. Following the the current growth trends out for a few years leads to a point where the program eats most of the federal budget. This, however is not a problem with Medicare per se. Medicare is the most efficient system we have in this country - the lowest admin expenses in the system itself and the lowest expenses for providers in dealing with it. The problem is how fast the underlying costs of health care are growing. It behooves nurses to take a serious interest in solving the problem because, if we don't, people will look to blame us - as in "Costs are rising so fast because nurses are overpaid."
A bunch of different ideas have been floated to fix the problem. They range from the technocratic to the ideological. It may be that the real answer lies in some mix? Here are some of those approaches and a few thoughts about them:
1. The Republican solution is to shift more of the cost to beneficiaries in one way or another. Raise the eligibility age, increase copays, or the Ryan plan, which stops guaranteeing Medicare as a federal benefit and gives the elderly a voucher to buy private insurance. The value of the vouchers would be capped, so each year the part paid by the beneficiaries would be larger. The non-partisan Congressional Budget office estimates that, even though the cost to the government would go down, the cost to individuals and employers would go up more, so net total cost would increase.
2. Cut payments to providers for any given service: This has been done to various degrees by both parties, but has done about as much as it can do. At some point, you push that as far as it can go and providers stop taking Medicare patients, or they cost shift to other patients, or they go into the red themselves, or some combination of those. What this story is about is hospitals fearing payment cuts so much they are pushing for more of Number 1 above to avoid them.
3. Try to reduce the use of unnecessary services: Various ideas are advanced for this. The "free market" approach is to make people pay more of the cost themselves so they will "shop more wisely" and consume less. The trouble is that the overconsumption of healthcare, where it exists, is not driven mostly by patients. There may be a few unnecessary visits to MD offices and there certainly are ER visits that could be handled in offices a lot cheaper. But the big ticket items are the unneeded tests, surgeries and procedures and it's mainly the docs and the medical culture that is responsible for those, not the patient. If you are lying on a gurney in the ER with chest pain and the doc says you need a heart cath, you aren't going to shop for a better price somewhere else and you aren't going to seriously question the judgement of the doc most of the time. But we do know that your chances of getting that heart cath - or any of a bunch of other procedures - varies widely from hospital to hospital and from region to region. And we know that some of the areas with the lowest cost have the best outcomes - more money spent does not equal better care.
I could write lots more, but I have to get on to other things now, but maybe that's enough for a conversation starter?