Benefits have also been expanded, with addition of hospice, mammography, pap smears, certain immunizations, and kidney dialysis and transplant. There also has been an explosion in the use of medical technology, further fueling high costs. One swift solution would be to raise taxes. For the time being, however, there seems to be a concensus against raising taxes. Which leaves cutting expenditures as the main route to reform.
Cost cutting implies squeezing the beneficiaries, providers or the system.
Some would means-test the Medicare entitlement or raise deductibles or copayments. Elders already spend twice as much of their income as non-elders on health care, with only half the income. Means testing would erode the very idea of social insurance. And it is unclear how much or how quickly savings can be wrung from the system. The financing and payment schemes of the two are completely distinct.