Medicare Now and in the Future by Marilyn Moon

Author:Marilyn Moon [Moon, Marilyn]
Language: eng
Format: epub
Tags: Social Science, Political Science, General
ISBN: 9780429834738
Google: -viADwAAQBAJ
Goodreads: 3855180
Publisher: Routledge
Published: 1993-04-28T00:00:00+00:00

CONCLUSIONS

The MCCA provided real benefits for a majority of older Americans and filled important gaps in the Medicare program. The simplification of Part A hospital benefits, the introduction of drug and respite benefits (even if quite limited), and the major and underestimated increase in the skilled nursing benefit would have wrought improvements in the healthcare coverage of older persons. Even many of those who already had Medigap coverage were likely to benefit. But the full measure of these improvements was not communicated well to beneficiaries.

It is, however, too easy to simply argue that older persons were misinformed. Analysts and policymakers ignored information that should have signaled problems. For years, older persons have demonstrated how much they like and are satisfied with the private supplemental policies that have grown up around Medicare. Displacing coverage that these policies now provide was not popular, and analysts could have anticipated that fact. Further, we have long known that universal programs enjoy much greater popularity in the United States than do means-tested ones. But the MCCA moved to change that formula, not to achieve major new benefits but to add marginal ones. The dramatic shift in the financing of Medicare was meaningful beyond the dollar value of the burden of the supplemental premium—it was a course change for Medicare that alarmed and angered many senior citizens. Fair or not, this was resented by many—even by those older persons who would have paid low premiums.

The MCCA also highlighted four important dilemmas that will continue to face health policy in the 1990s. First, it is expensive to make even minor expansions in large programs without large cost increases. Just adding $100 worth of new benefits means $3.8 billion in new costs, and these days, $100 buys relatively little healthcare. Second, individuals' perceptions of the value of such benefits lag behind their costs, resulting in sticker shock on the part of consumers and taxpayers. The value of these benefits was discounted by Medicare enrollees, but in truth, the average taxes that had to be raised were equivalent to the costs of the benefits. Third, a flat catastrophic cap set low enough to help those with low and modest incomes is very expensive, and not as generous as higher-income individuals could afford. Low-income persons need more help than we as a society feel we can afford for all beneficiaries in this era of fiscal stringency. Fourth, recognition of the varying economic circumstances of Medicare beneficiaries creates challenges to find a means to adapt the program to the needs of those who are still vulnerable without undermining strong public support for Medicare.

The repeal of the MCCA did not mean the end of changes in Medicare. The 1990s and beyond will continue to present many challenges for the program, challenges that can be faced intelligently only with knowledge of the lessons that the MCCA offers.

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