Medicare Reform: The Larger Picture

摘要

Attempts to reform Medicare reflect pressures from diverse groups: The elderly complain about Medicare's failure to cover drugs; budget-balancers fear escalating expenditures; hospitals and physicians deplore inadequate reimbursement that forces them to skimp on services; and stakeholders in education, housing, child care, and defense see Medicare as an 800-pound gorilla that crowds out everything else. At the most fundamental level, the "Medicare problem" is best understood as the interaction of two larger problems: 1) providing for the overall financial needs of the elderly; and 2) developing a more efficient, equitable medical care system for Americans of all ages. Unless there is progress on these larger problems, Medicare reform is likely to be ineffective and ephemeral. If the political climate blocks such progress in the short term, those seeking to change Medicare should at least take cognizance of the larger picture, and, following the first rule of good medical practice, "do no harm." This paper discusses several current myths about Medicare, presents a framework for thinking about the larger problems, and offers a policy approach for the long run.