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The budget President Obama will send to Congress Wednesday is expected to include some $400 billion in reductions to Medicare and other health programs.

And if the word around Washington is correct, it may also include a proposal aimed at winning some bipartisan backing – by changing the way Medicare patients pay for their care.

But there have been previous efforts to streamline Medicare's antiquated system of deductibles and copayments. And none, so far, has been successful.

Tom Miller, a resident fellow at the conservative American Enterprise Institute, says having separate deductibles and co-insurance schemes for Medicare's parts A and B is an anachronism that dates back to the 1960s, when Medicare was created.

"That's been a legacy which has been very hard to change," he says, "because it requires an act of Congress, which requires agreement ... which tends not to be the case."

Currently, Medicare Part A, which covers hospital and skilled nursing home care, and Part B, which covers doctor and outpatient costs, have separate deductible and copayment schemes. This year the Part A hospital deductible is $1,184; the Part B outpatient deductible is $147.

Miller is one of many economists who say it would make much more sense to have a single, merged deductible of around $500. That, however, would likely make many patients pay more. That's because most Medicare patients aren't hospitalized in a given year, but they do almost all go to the doctor.

Under most of the proposals floating around, said Howard Bedlin, vice president for public policy and advocacy of the National Council on Aging, "about 30 million beneficiaries would end up paying more and about 2 million would end up paying less."

In exchange, however, says Miller, beneficiaries would likely get something they don't get now – "stop-loss" protection. That agreement for Medicare to cover all of a patient's medical costs after he or she reaches a specific threshold is something the program currently – and almost inexplicably – lacks.

"That's the world in which you need insurance," Miller says. "But Medicare traditionally doesn't have that type of structure."

Shots - Health News

The Hidden Costs Of Raising The Medicare Age

The United States lost close to 6 million manufacturing jobs between 2000 and 2009. Now, slowly, some of those jobs are coming back. Over the past three years, the U.S. economy has gained a half-million manufacturing jobs.

But even with the manufacturing recovery, there are both winners and losers — and sometimes they're created by the same company.

Take the case of the Swedish manufacturer Electrolux. A century ago, it got its start in vacuum cleaners, and now it makes a wide range of appliances. It's the world's second-largest appliance manufacturer behind Whirlpool, owns the Frigidaire brand and makes Kenmore products as well.

In 2004, Electrolux began a major restructuring, shuffling jobs from high-cost to low-cost areas, from Sweden to Hungary, from England to Poland and from Denmark to Thailand. This summer, Electrolux will begin moving jobs from a town outside Montreal to Memphis, Tenn., where it will begin production of ovens and stoves in a brand-new, high-tech plant.

With the move, Electrolux will go from paying a base union wage of close to $19 an hour in Canada to roughly one-third less in Memphis. The company is expected to eventually hire about 1,200 people at the Memphis location.

'Back To The Future'

Jack Truong, president and CEO of Electrolux Major Appliances North America, won't speculate on how long the company might stay in Memphis. The company has not committed to a minimum amount of time, but Truong says Electrolux is committed to working with Memphis to build success so that it can stay there for the long term.

Memphis Mayor A C Wharton is delighted about the jobs. "We're actually going back to the future here. This used to be a heavy manufacturing city," he says.

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On the importance of luck and family connections

"[Success] is so much about luck — that's the real thing — or it's often about class. I mean, if you were born into a family with connections, that is huge.

"[Jules] doesn't [have family connections]. And she doesn't understand that in the beginning when she thought that they all started out the same and that their lives would have a trajectory in sort of lockstep — like the Rockettes, going off into the world kicking at the same pace. ... When my friends and I first moved to the city, everybody lived in these junky little apartments and we all had takeout from Chinese restaurants and we all just sort of lived the same semi-marginal lives. But as time went on, and this is true in this novel, certain things could somehow take effect. Like if you were an artist, instead of getting a job as a paralegal, maybe your parents would give you money and you could go off and rent the cottage of a friend in Maine and you could really write a novel there. Whatever it was, she didn't understand that that was going to happen. She thought it was all even and it was all fair, and of course nothing's even and nothing's fair."

On Jules' struggle with envy for Ethan and Ash

"I was really interested in the subject of envy. But not that kind of big, overt envy, but instead the kind of quiet envy that you might feel for people you really love. She doesn't have — Jules — a big, big talent. So she becomes a therapist. She actually is pretty good at it and her patients love her. But then she looks over and over there in the distance are Ash and Ethan and they are living a life that she always thought was possible for her. So, can you enjoy your life? Is it enough if you're the therapist married to the really nice husband? What's enough to do with your talent and your brain?

“ It's like your life gets put through a funnel, and you see what remains.

"In any case — although I did not know it then — to fall asleep on Ifat's bed was milk enough, to sleep in crumbling rest beside her body. Sometimes like water she runs through the sentences of sleep, a medium something other than itself, refracting, innocent of all the algae it can bear and capable of much transmogrification. Her water laps around me almost in reproach: '"You were distracted, when I requested your attention. You were not looking. I was milk."'

The elegiac immediacy of this passage, the elaborateness of its metaphor, the language teetering on the edge of overreach — these are hallmarks of Meatless Days. Here, she describes her stubborn grandmother dragging home to her appalled family a live goat to be butchered for the festival of Eid: "Like a question mark interested only in its own conclusions, her body crawled through the gates ... moving in her eerie crab formations, [she] ignored the hangman's rope she firmly held as behind her in the gloaming minced, hugely affable, a goat."

Comedy and tragedy, tenderness and horror, sit close to one another in this remarkable book, doing justice to the piecemeal, intimate ways memory actually lives in the mind.

You Must Read This is produced and edited by the team at NPR Books.