Publications on Medicare

Health reform - the "let’s do lunch" of public policy - is on everyone's lips in Washington. But like many long-postponed, obligatory meals, who is going to pick up the check? Capping the tax exclusion of employer-sponsored insurance (ESI) - an idea loved and loathed by politicians from both parties - is on the table to pay for subsidies for the uninsured and to moderate companies’ incentives to offer high-end coverage.

More than 250 million Americans-more than 80 percent of us- have health coverage, usually through employers or Medicare, Howard Gleckman points out in a USA Today commentary. By contrast, just 7 million have long-term care insurance. That, it seems, is the real crisis of the uninsured.

Medicare and other insurers generally ignore the importance of established chronic illnesses in generating demands on the health care system and escalating costs, Institute Fellow Robert Berenson told the House Ways and Means Committee. At the same time, delivery system reforms are likely to fail unless immediate steps are taken to address the likely collapse of the primary care physician workforce in many parts of the country. He also underscored the need for a public plan -- patterned on Medicare but separate from it -- as an option for those seeking care.

In this Press-Enterprise (Riverside, California) commentary, John Holahan explains that Medicaid has done a good job of keeping costs under control and that its increase in spending is caused by the swelling number of enrollees, particularly in a weak economy. The 7 million people eligible for both Medicaid and Medicare are not dealt with in a cost-effective way, though, and transferring responsibility for them to the federal government would pave the way for health reform.

In testimony before the Senate Finance Committee, Robert Berenson, M.D. explores possible reasons that integrated care organizations that include multispecialty group practices have not become a major feature of the U.S. health system despite prominent success stories. These organizations are often penalized financially for undertaking activities that reduce costs because the benefits of efficiency are not internalized to the organization. Berenson makes the case that current payment incentives embedded in Medicare and private payer approaches promote behavior that may not benefit patients, such as rewarding preventable hospitalizations and producing a mismatch between the services patients need and those that fee schedules encourage.