Tyler Cowan builds an argument on the presumption that Christian Scientists can opt out of Medicare. The Medicare benefit provides no such thing (at p 42):
- Christian Scientists pay into Medicare like anyone else with wage income.
- They can sign an election form that enables a qualifying Christian Scientist inpatient facility to bill Medicare Part A for their stay, in lieu of otherwise obtaining medically necessary Part A benefits. Think of this as a Christian Scientist hospice benefit.
- If they need Medicare in a regular Part A facility or Part B service, that election is instantly revoked when they get the service, without delay or questions.
- If #3 happens, Medicare can delay a subsequent election under #2 for 1-5 years.
We can question the policy of this particular religious accommodation in Medicare benefits, but this isn’t an opt out.
If you want opt out models, try the Amish, Catholic nuns and conservative Christians. Self-employed Amish can fully opt out from both Social Security and Medicare (IRC § 1402(g) and § 3127). Religious orders under a vow of poverty can opt out in §3121(r). Most recently, the ACA provided a religious exemption from the individual mandate (but not Medicare) for “health care sharing ministries” (§§ 1311(d)(4)(H), 1501(b) of the ACA, codified in § 5000A(d)(2) of the IRC).
UPDATE: In the comments, Tyler says I misunderstand his argument. The title of his post is: A Christian Scientist’s guide for opting out of Medicare. My main point is that Christian Scientists can’t “opt out of Medicare,” but other religious groups can. I’ll talk about the policy of various forms of opt out in another post.