Medicare aimed, above all, to improve access to health care services for the most disadvantaged elderly by removing distributional, attitudinal, and financial barriers. Legislative intent was based on sketchy statistical evidence of need and enriched by extensive testimony of hardship. By more precise measurements, the mature Medicare program is shown to have been largely successful. Yet, some problems of access remain, and some costly side effects are identified.
Renewed national interest in market forces to promote more efficient and cost-conscious behavior by patients and providers increasingly focuses on the structure of private health insurance benefits. Two features of procompetitive legislative proposals are considered: a ceiling on tax-free employer insurance premiums and offering greater choice of insurance plans. The interests of efficiency and equity invoke different kinds of risks and transfers; no single institutional approach is likely to yield the promised benefits.
As the availability and quality of our national data-gathering systems have increasingly been taken for granted, concern and protection for these resources have been relaxed. This has resulted in the loss of a focus for statistical policy and coordination, a diminution in the size of samples taken, a retrogression in the amount of data collected, and the neglect of social and economic research. It is the responsibility of government, labor, business, and users of data to demand a national statistical coordination that maintains quality, integrity, and independence.
Public policies regarding health care for the elderly--including the Medicare program--are reconsidered with respect to six critical areas: the number of elderly, their health status, use of medical care, labor force participation, income, and their living arrangements.
The Medicare program faces serious financing problems for both hospital and physician services. Spending on medical care is growing more rapidly than national income. The sources and magnitude of the problems are outlined, and a range of approaches explored. Resolution will come from coordination and interaction among several of these approaches to reducing outlays and increasing revenues.
Medicare is financed principally by taxes--some of which burden the general population and others the elderly beneficiaries. Proposals to adjust these revenue sources are evaluated for equity, efficiency, stability, and administrative costs. A package is offered to redistribute the tax burden among all groups; it may also be good health policy.
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