The Future of Medicare

From time to time, DemocracySpace joins other public-interest blogs in writing about an issue proposed by Facing Up to the Nation's Finances, a non-partisan project on the long-term implications of the federal budget. (See our past contributions on the national debt and Social Security.) This month, Facing Up has asked us to consider the future of Medicare.

Like Social Security, Medicare is part of a compact between generations in our country - but also like Social Security, it faces serious funding challenges as Baby Boomers begin to claim benefits and as Americans live longer than ever. Everyday Democracy promotes large-scale, action-oriented public dialogue on issues of pressing interest to communities, but it's apparent that we need national discussions, too. The Facing Up website offers a "Choicework" discussion guide to help citizens navigate options on what to do about Medicare. Three main perspectives are offered, each accompanied by arguments for and against the stance and action steps that we'd take as a nation if we embrace that perspective. The perspectives are, in brief ...

Maintain our current commitment to the elderly - "Medicare is a promise that whatever health care retired individuals need will be covered at public expense. That promise must be honored, even if it means raising taxes or reducing spending in other areas. As things stand, elderly persons are paying more than ever for out-of-pocket medical expenses that are not covered by Medicare. Minor adjustments can be made to reduce the program's cost, and aggressive measures should be taken to reduce fraudulent claims. But it is immoral and unthinkable to reduce medical benefits for the nation’s seniors."

Make Medicare affordable by focusing on those who need it most - "Unless we revisit what Medicare promised, the program will drive up either our taxes or our national debt so much it will cripple the nation. Before the Baby Boomers retire, we need to pare down benefits to make them more affordable. Even more importantly, we need to change the system so that affluent retirees pay more of their own health care costs. In this way, we can maintain benefits for those who need them the most."

Make health care in retirement a personal choice, not a shared responsibility - "We would be better off if Medicare were no longer a public program for older Americans. Instead, it should be replaced by a combination of required and voluntary individual medical savings accounts. This approach would make health care in old age more a matter of personal responsibility, rather than a government or social responsibility. This would encourage people to take care of themselves, while relying on market forces to bring costs down."

Which of these views comes closest to your own? Do you think the issue is being sufficiently discussed in the presidential campaign or by your congressional candidates? As we discuss possible solutions, can we start saving money for the government, taxpayers, and health-care consumers through options including streamlined medical records and electronic prescriptions, lifelong preventive care, negotiated prescription drug prices, and other steps?

We've written in the past about the pioneering blog written by Health and Human Services Secretary Mike Leavitt, and he has made many posts about Medicare that you can read here, including his department's decision earlier this year to trip a trigger aimed at cutting Medicare funding if it takes up too much of the general fund in the federal budget. But others contend that the trigger mechanism (enacted in the Medicare Modernization Act of 2003) is nothing but a means to undermine Medicare in favor of privatized medicine; read one such view here.