Social Safety Net — No One Falls Through

Social Security, Medicare, and Medicaid are America's most successful anti-poverty programs. But the retirement system is inadequate. US elder poverty stands at 20–23% versus Denmark's 5.0%, driven by a net pension replacement rate of 49.4% — among the lowest in the OECD. Median retirement savings for ages 55–64 is just $185,000 — less than 15% of what's needed. For the bottom 40% of retirees, Social Security already provides 84% of total income, yet benefits have lost ~36% of purchasing power since 2000 because COLA uses CPI-W, which underestimates senior spending on healthcare and housing.

Traditional Medicare is the only major insurance without an annual out-of-pocket maximum. It excludes dental, vision, and hearing — hearing aids alone run $4,000–$6,000. Meanwhile, Medicare Advantage costs taxpayers $76–84 billion per year more than Traditional Medicare through systematic upcoding. In 2024, there were 4.1 million prior authorization denials; 80.7% were overturned on appeal, showing plans profit from delay and denial. One in four US seniors spent more than $2,000 out of pocket on healthcare last year.

The disability system is inaccessible by design. 30,000 people died waiting for SSDI decisions in FY2023. Initial denial rate: 61–67% — most eventually approved, showing it's a timing problem, not a merit problem. Average wait: 231 days initial + 342 days appeal = 573 days. ALJ approval rates vary from 10% to 90% depending on the judge. Average SSDI benefit: $1,537/month. One in four SSDI recipients lives below the poverty line.

Medicaid work requirements backfire. Arkansas implemented them in 2018: 18,000 people lost coverage, zero employment gains. The 2025 reconciliation law projects 4.8 million newly uninsured. Fourteen states still refuse Medicaid expansion, leaving 1.4 million people in the coverage gap for no reason other than political hostility. Work requirements don't create jobs; they create paperwork barriers that remove healthcare from people already working or medically unable to.

For low-income retirees, the bottom two quintiles get an immediate $200/month benefit increase — $2,400 a year. The Special Minimum Benefit rises to 125% of the poverty line for workers with 30+ years of contributions. Caregiver credits (up to 5 years of Social Security work credits for unpaid family care) recognize unpaid care work — typically women — as a real contribution. CPI-E switch plus a 3% minimum COLA ensures benefits keep pace with actual senior spending, reversing the 36% purchasing power loss since 2000.

For seniors on Medicare, Traditional Medicare gains dental, vision, and hearing coverage — hearing aids alone run $4,000–$6,000 without insurance. A $5,000 annual out-of-pocket maximum caps catastrophic costs (Traditional Medicare currently has none). Drug negotiation extends to all Medicare drugs with a $35 insulin cap for every American. Medicare eligibility drops to 60, pulling ~5 million people out of the dysfunctional individual market. MA reform redirects $76–84B in annual overpayments from insurers to actual care.

For disabled workers, SSDI decisions come in 90 days instead of 573. ALJ standardization holds judges accountable for approval rates below 30% or above 80% — eliminating the random-judge lottery. The benefit cliff becomes a 50¢ phase-out instead of a hard cutoff, removing the trap that forces disabled workers to hide earnings. Five-year extended Medicare when returning to work eliminates the healthcare cliff. Rehabilitation-first assessment offers vocational rehab before a final determination.

For Medicaid beneficiaries, block grant proposals are off the table. The 1.4 million-person coverage gap closes with a 138% FPL federal floor. Work requirement bans restore coverage to 18,000+ in Arkansas and stop the 2025 reconciliation law's projected 4.8 million coverage losses. HCBS expansion shifts long-term care from institutions to homes — transforming the senior care experience from spend-down destitution to community-based support.