I need to think about this one for a while, but Drum points out: why not make the dead pay for their own Medicare?
His plan, in sum, is that whatever medical care you get during your old age will be free. You'll receive a bill, of course, so you can keep track of it, but you don't owe a dime.
Your estate will. What this essentially means is your estate will have first claim on any money you owe them.
Illogical? Tell that to the IRS, who also has priority claim to your estate. Not sure how that would work out in the end. The IRS is responsible for collecting Medicare taxes from your earnings, so I imagine not too much would change. The IRS would merely add your medical care to their filings against your estate.
This way, you get to keep and spend more of your money while alive, and your heirs would have less to inherit when the time comes. We might even throw in a proposal that the Medicare reimbursements would take first priority even over taxes, thus reducing the size of the estate.
Interesting idea, Kevin.