I understand where Austin Frakt is coming from in saying he wishes the doc fix deal could have been implemented from within the Medicare program's future planned spending. It has been implemented by reducing the amount of subsidy that goes to persons with incomes above 133% of poverty (below that they would be covered by Medicaid) and 400% (where the subsidy will cut off). This means that some federal spending has been moved from the 'under-65 box' to Medicare as compared to the new baseline created by the Affordable Care Act.
Of course, it was controversial to achieve expansions of health insurance by reducing planned Medicare spending by around $500 Billion over the first 10 years of the ACA; this was shifting money from the Medicare box to the under-65.
We need to keep an eye on the cross subsidy of the 'boxes' in our health system, but we first and foremost need to improve the health care system of our nation. It costs too much and there is ample evidence we are not getting our monies worth for what we spend. And there are 50 odd Million people who are uninsured.
There is a disconnect in focusing too much on the various 'boxes of coverage' in our country. When we reduce Medicare spending to fund insurance subsidies, the people newly receiving coverage are of course the children and grand-children and great-grandchildren of Medicare beneficiaries. Who are paying the payroll taxes necessary to fund Medicare, which is of course providing care to their parents, grand parents and great grand parents.
We have got to develop a system that makes sense for the young and old alike, realizing that the former will eventually become the latter.