President Joe Biden’s 2024 proposed budget includes plans to shore up the finances of Medicare, the federal health insurance program that covers Americans who are 65 and up and some younger people with disabilities.

His administration aims to increase from 3.8% to 5% an existing Medicare tax that’s collected on the labor and investment earnings of Americans who make more than US$400,000 annually. It also aims to reap some savings from having the government negotiate prices on more prescription drugs.

The White House projects that these changes would generate an additional $650 billion in revenue over a decade. Some independent experts concur.

As economists who have long researched the Medicare and Social Security programs, we believe the president’s proposal is an important first step in opening the necessary debate on strengthening Medicare’s finances.

Part A’s precarious funding

Medicare consumes more than 15% of the federal budget. The program cost $975 billion in 2022, out of the government’s $6.5 trillion in total federal spending.

As anyone who has enrolled in it can tell you, the program itself is rather complicated. It’s divided into three parts, known as A, B and D, each of which relies on revenue from a different mix of sources.

Medicare Part A covers care delivered at hospitals and nursing homes, as well as home health care. Part B pays for doctor’s visits and outpatient procedures, and Part D pays for prescription drugs. There’s also Part C, a private insurance option, known as Medicare Advantage. However, its costs are included in the accounting for Parts A and B.

Part A is primarily funded by a 1.45% Medicare payroll tax on both employees and employers. When that tax and the program’s other tax revenues don’t raise enough money to cover Part A’s costs, the program dips into the Medicare Hospital Insurance trust fund to make up the difference. The trust fund, amassed from past surplus payroll taxes, currently stands at around $143 billion.

Without spending cuts, funding increases or a combination of the two, the Medicare program’s trustees have predicted in their annual report that the Medicare trust fund will be exhausted by 2028. The trustees are the secretaries of the Treasury, Labor and Health and Human Services departments, plus the Social Security commissioner. There can be up to two additional trustees, but those seats are vacant.

Medicare’s expenses are rising rapidly with the retirement of baby boomers, the large generation of Americans born between 1946 and 1964, and rising health care costs.

Should the trust fund be emptied out, the trustees predict that hospital benefits would have to be cut by 10%. But those cuts are widely considered to be politically unacceptable, as illustrated by statements from Biden and his predecessor, former President Donald Trump.

In addition to proposing an increase in the tax levied on the investment earnings of high-income Americans, Biden also proposes that these revenues be fully dedicated to the trust fund. Currently the government treats that money as general revenue that can be used for any government program.

2 very different scenarios

Unlike Medicare Part A, Parts B and D are funded largely by general federal revenue and by premiums paid by retirees.

Because the government is allowed to use general revenue to pay for them, the funding of Parts B and D isn’t jeopardized by the depletion of their trust fund – no matter how fast those costs rise.

Even without Biden’s proposed changes, official Medicare spending projections rise rapidly through the mid-2030s and then plateau as a percentage of gross domestic product.

However, those projections are based on a presumption that payments to hospitals are constrained as specified in the Affordable Care Act and that other spending constraints on physician payments are realized.

Unfortunately, history provides little assurance that lawmakers will maintain all of these requirements to restrain future payments to health care providers.

We say this because of what happened after 1997, when Congress approved the sustainable growth rate system, which was intended to limit the annual increase in cost per Medicare beneficiary to the rate of economic growth. Starting in 2002, Congress passed legislation year after year to override it – and only stopped doing that once it did away with the system altogether in 2015.

Reflecting this uncertainty, the annual trustees report features an alternative projection that is arguably more credible and more scary. It indicates that Medicare costs will grow much faster than the economy starting in 2036.

Competing demands

The Social Security program, a national pension program that primarily supports older Americans, faces similar funding shortfalls.

Its trustees anticipate that the Social Security trust fund will be depleted by 2035 without changes in funding, promised benefits – or both. In that event, Social Security benefits may have to fall by about 20% from anticipated levels.

Medicare and Social Security are the nation’s largest entitlement programs. Almost all Americans, if they live long enough, will eventually be eligible to obtain these benefits – regardless of their income or wealth.

While Americans do not yet agree on how to put these programs on a steadier fiscal footing, the math is clear.

Our elected representatives cannot avoid making hard decisions that involve increasing taxes, reducing benefits or both.

Dennis W. Jansen, Professor of Economics and Director of the Private Enterprise Research Center, Texas A&M University and Andrew Rettenmaier, Executive Associate Director of the Private Enterprise Research Center, Texas A&M University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Historian Vicki Crawford was one of the first scholars to focus on women’s roles in the civil rights movement. Her 1993 book, “Trailblazers and Torchbearers,” dives into the stories of female leaders whose legacies have often been overshadowed.

Today she is the director of the Morehouse College Martin Luther King Jr. Collection, where she oversees the archive of his sermons, speeches, writings and other materials. Here, she explains the contributions of women who influenced King and helped to fuel some of the most significant campaigns of the civil rights era, but whose contributions are not nearly as well known.

An activist in her own right

Coretta Scott King is often remembered as a devoted wife and mother, yet she was also a committed activist in her own right. She was deeply involved with social justice causes before she met and married Martin Luther King Jr., and long after his death.

Scott King served with civil rights groups throughout her time as a student at Antioch College and the New England Conservatory of Music. Shortly after she and King married in 1953, the couple returned to the South, where they lent their support to local and regional organizations such as the NAACP and the Montgomery Improvement Association.

They also supported the Women’s Political Council, an organization founded by female African American professors at Alabama State University that facilitated voter education and registration, and also protested discrimination on city buses. These local leadership efforts paved the way for widespread support of Rosa Parks’ resistance to segregation on public busing.

Following her husband’s assassination in 1968, Scott King devoted her life to institutionalizing his philosophy and practice of nonviolence. She established the King Center for Nonviolent Social Change, led a march of sanitation workers in Memphis and joined efforts to organize the Poor People’s Campaign. A longtime advocate of workers rights, she also supported a 1969 hospital workers’ strike in South Carolina, delivering stirring speeches against the treatment of African American staff.

Scott King’s commitment to nonviolence went beyond civil rights at home. During the 1960s, she became involved in peace and anti-war efforts such as the Women’s Strike for Peace and opposed the escalating war in Vietnam. By the 1980s, she had joined protests against South African apartheid, and before her death in 2006, she spoke out in favor of LGBT rights – capping a lifetime of activism against injustice and inequalities.

Women and the March

While Scott King’s support and ideas were particularly influential, many other women played essential roles in the success of the civil rights movement.

Take the most iconic moment of the civil rights struggle, in many Americans’ minds: the Aug. 28, 1963, March on Washington for Jobs and Freedom, at which King delivered his landmark “I Have a Dream” speech on the steps of the Lincoln Memorial.

As the 60th anniversary of the march approaches, it is critical to recognize the activism of women from all walks of life who helped to strategize and organize one of the country’s most massive political demonstrations of the 20th century. Yet historical accounts overwhelmingly highlight the march’s male leadership. With the exception of Daisy Bates, an activist who read a short tribute, no women were invited to deliver formal speeches.

Women were among the key organizers of the march, however, and helped recruit thousands of participants. Dorothy Height, president of the National Council of Negro Women, was often the lone woman at the table of leaders representing national organizations. Anna Arnold Hedgeman, who also served on the planning committee, was another strong advocate for labor issues, anti-poverty efforts and women’s rights.

Photographs of the march show women attended in large numbers, yet few historical accounts adequately credit women for their leadership and support. Civil rights activist, lawyer and Episcopalian priest Pauli Murray, among others, called for a gathering of women to address this and other instances of discrimination a few days later.

Hidden in plain view

African American women led and served in all the major campaigns, working as field secretaries, attorneys, plaintiffs, organizers and educators, to name just a few roles. So why did early historical accounts of the movement neglect their stories?

There were women propelling national civil rights organizations and among King’s closest advisers. Septima Clark, for example, was a seasoned educator whose strong organizing skills played a consequential role in voter registration, literacy training and citizenship education. Dorothy Cotton was a member of the inner circle of the Southern Christian Leadership Conference, of which King was president, and was involved in literacy training and teaching nonviolent resistance.

Yet women’s organizing during the 1950s and 1960s is most evident at local and regional levels, particularly in some of the most perilous communities across the deep South. Since the 1930s, Amelia Boynton Robinson of Dallas County, Alabama, and her family had been fighting for voting rights, laying the groundwork for the struggle to end voter suppression that continues to the present. She was also key in planning the 50-mile Selma-to-Montgomery march in 1965. Images of the violence that marchers endured – particularly on the day that came to be known as Bloody Sunday – shocked the nation and eventually contributed to the passage of the landmark Voting Rights Act of 1965.

Or take Mississippi, where there would not have been a sustained movement without women’s activism. Some names have become well known, like Fannie Lou Hamer, but others deserve to be.

Two rural activists, Victoria Gray and Annie Devine, joined Hamer as representatives to the Mississippi Freedom Democratic Party, a parallel political party that challenged the state’s all-white representatives at the 1964 Democratic Convention. A year later, the three women represented the party in a challenge to block the state’s congressmen from taking their seats, given ongoing disenfranchisement of Black voters. Though the congressional challenge failed, the activism was a symbolic victory, serving note to the nation that Black Mississippians were no longer willing to accept centuries-old oppression.

Many African American women were out-front organizers for civil rights. But it is no less important to remember those who assumed less visible, but indispensable, roles behind the scenes, sustaining the movement over time.

Vicki Crawford, Professor of Africana Studies, Morehouse College

This article is republished from The Conversation under a Creative Commons license. Read the original article.