Ever since Bush claimed his "mandate" (meaning he actually got more votes than the other guy in this election), we’ve been hearing a little too much about social security reform. As San Francisco standalone journalist Chris Nolan points out in her blog Politics from Left to Right, the real "reform" in question is the de-linking of social security payments from wages to inflation, which will eventually reduce the value of the benefit. The privitization thing is just a sop to Wall Street.

Turns out that the Brits did this delinking a while ago and then privatized a segment of their state pensions by paying such huge bribes in tax incentives that it actually cost the government money. Then because interest rates dropped well below the levels at which the private plans had forecast their investment returns in the 1980s, they don’t have enough to pay the pensions at the rate that those few who stayed behind in the government plan (called SERPS) are getting. Not a pretty picture, and one well described in this article from the American Prospect, which though it appears in a lefty journal is written by a Financial Times reporter.

Why am I writing about social security in a health care blog? Good question. My primary focus on health insurance is that it ought to be a form of social insurance because the payments required for it are very uneven (some people are sick–others are not). Theoretically you might be able to design a largely private pension/savings system that might actually work and not compound social inequality. We already have private pensions from both employers and 401K and other plans for individuals that provide some mechanisms for savings and retirement. So there is the basis for a mixed public-private system–not unlike in health care.

Furthermore the separation of social security from general taxation is mostly an accounting sham which also allows the those earning substantially more than $87,000 a year to pay a proportionately lower share of their income in tax than those earning less–something that is clearly regressive but explained away by the concept that it’s a savings plan. So I’m not against reform per se, especially if the tax inequity was changed.

However, Paul Krugman in his latest NY Times op-ed lays out clearly that the attempt by the Bush Administration to privitize social security is going to cost a whole lot of money while these individual accounts are set up. And that lack of money is going to add to the deficit, which in the end will require less money to be spent on other things as we instead spend money servicing the national debt. What are those other things? Well, apart from servicing the debt Federal and state governments really only spend money on three things–defense, education and health care. Guess which one of these will get cut first.

Furthermore, the diversion of tax revenues into private accounts leaving a shortfall in the overall amount needed for keeping current benefits in social security has an eerie parallel in the diversion of money from the health insurance risk pool to HSA accounts. And in one more parallel, I have an HSA account with less than $2,000, and I pay a fee of $20 a year to manage it. Not a huge fee by any means, but assuming that it’s related to costs, I suspect that’s a much larger cost than what the government pays to manage social security accounts. In fact the management fees on British private pension accounts were so high the industry was forced into a huge settlement with its customers.

So as we head towards a self-funded, individual insurance funding future, there must be strong questions asked about the impact on health care, and society’s ability to pay for what’s needed for its less wealthy citizens.