In a few short weeks — conveniently after Election Day — the federal government will be mailing an unwelcome message to affluent retirees: You'll pay more for Medicare because you earn more.

That rip you see in the retirement safety net is called means-testing. Expect that hole to get bigger.

Slipped into the 2003 Medicare prescription drug legislation at the last minute by a congressional conference committee, the provision means that wealthier seniors will have to pay a greater share of the cost of doctor visits.

Medicare Part B covers outpatient services such as doctor visits, physical therapy and X-rays. Seniors who choose the coverage pay 25 percent of their monthly Part B premium, with the government picking up the remaining 75 percent. The seniors' monthly part was $78.20 last year and rose to $88.50 this year.

Beginning in 2007, wealthier seniors will have to pay a higher percentage of the premium costs. Singles with annual incomes of $80,000 to $100,000 and couples with annual incomes of $160,000 to $200,000 will have to pick up 28 percent of the monthly premium cost. That share will rise to 35 percent by 2009. Singles with annual incomes of more than $200,000 and couples with annual incomes of more than $400,000 will pay 43 percent of the cost next year, rising to 80 percent in 2009.

About 4 percent of beneficiaries will be affected initially, but that number is expected to double in 10 years.

Critics — inevitably led by seniors' advocacy groups — see this change as a violation of the principle upon which Medicare was founded. They argue that the program is social insurance, whereby workers and employers collectively fund government programs designed to protect ourselves and our neighbors against life's hardships: old age, unemployment, ill health and disability.

All contributors pay equal tax rates, and participants benefit from the programs based on presumed (rather than actual) destitution. Until now, the retired, sick and out-of-work have been considered in need of financial assistance, no questions asked.

The idea that the wealthy pay a higher rate for social insurance programs doesn't sit well. Still, means-testing recognizes Medicare and other social insurance programs for what they are: redistribution of wealth using government as a broker.

We have come full circle on Medicare. Created in 1965, Medicare was actually compromise legislation with its roots in the Truman administration, which had vigorously promoted universal healthcare. That proposal went nowhere, so postwar health reformers chose to exploit the burdens — real or imagined — of the aged as a ploy for sympathy to get universal care for at least one group of Americans. The opposition's main criticism then was that too many retirees are not poor enough to warrant government-subsidized health insurance.

Medicare was created in the afterglow of Lyndon B. Johnson's 1964 blowout election victory over Barry Goldwater.

Critics believe that means-testing will spread like a bad case of poison ivy and devolve into a welfare program as Medicare inevitably gets into deeper financial trouble. It could happen vertically by taking next year's $80,000 trigger point for higher payment rates and dropping it to $60,000 or even $40,000 over time. Or it could spread horizontally by requiring people with higher incomes to pay more for specific benefits under the hospitalization and prescription drug portions of Medicare. And, ultimately, the contagion could spread to Social Security.

Medicare means-testing was enacted briefly in 1988, when President Reagan signed into law a "supplemental premium" for affluent beneficiaries. It was repealed a year later after vigorous opposition from older adults. The lack of outrage this time may reflect either the stealth nature of this increase or a realization by the electorate that the program really is in trouble.

There was unusual unanimity in Congress, where conservative Republicans see it as fiscally responsible and Democrats see it as a progressive means of taxation.

Means-testing represents a huge and potentially dangerous philosophical shift. But it is less unsavory than the alternatives: cutting benefits, rationing care or raising the eligibility age.

We are in deep denial about what is coming with Medicare and Social Security. Averting our eyes is certainly not the answer.

Steve Jacob is a member of the Fort Worth (Texas)Star-Telegram Editorial Board.