Medicare: Preparing for the Challenges of the 21st Century (Conference of the National Academy of Social Insurance)

670 Pages·1998·2.4 MB·English

by  Robert D. Reischauer

Medicare : Preparing for the Challenges of
title:
the 21st Century
author: Reischauer, Robert D.
publisher: Brookings Institution Press
isbn10 | asin: 0815773994
print isbn13: 9780815773993
ebook isbn13: 9780585041650
language: English
Medicare--Congresses, Medicare--
subject
Forecasting--Congresses.
publication date: 1997
lcc: RA412.3.M43 1997eb
ddc: 368.4/26/00973
Medicare--Congresses, Medicare--
subject:
Forecasting--Congresses.
Page iii
Medicare
Preparing for the Challenges of the 21st Century
Robert D. Reischauer
Stuart Butler
Judith Lave
Editors
NATIONAL ACADEMY OF SOCIAL INSURANCE
Washington, D.C.
Page iv
Copyright © 1998
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Library of Congress Cataloging-in-Publication Data
Medicare: preparing for the challenges of the 21st century / Robert D.
Reischauer
[et al.], editors.
p. cm.
Includes bibliographical references and index.
ISBN 0-8157-7399-4 (alk. paper)
1. MedicareCongresses.
2. MedicareForecastingCongresses.
I. Reischauer, Robert D. (Robert Danton), 1941- .
RA412.3.M43 1997
368.4'26'00973dc21 97-33931
CIP
9 8 7 6 5 4 3 2 1
The paper used in this publication meets the minimum requirements
of the American National Standard for Information
SciencesPermanence of Paper for Printed Library Materials, ANSI
Z39.48-1984
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Page v
Preface
The primary purpose of the ninth annual conference of the National
Academy of Social Insurance, which was held in Washington, D.C.,
on January 2324, 1997, was to provide a forum at which the major
issues that confront Medicare over the long run could be addressed in
a dispassionate and informed manner. Those who spoke and presented
papers identified a wide range of options that Congress and the
president could consider as they debated ways to strengthen the
program. They also offered a number of principles that could be used
to guide the restructuring effort.
Many of these issues and options were debated when Congress and
the president devised the Medicare titles of the Balanced Budget Act
of 1997. That act, which together with the Taxpayer Relief Act of
1997 promises to balance the budget by 2002, will reduce the growth
of Medicare spending by between $112 billion (Congressional Budget
Office estimate) and nearly $150 billion (Office of Management and
Budget estimate) by fiscal year 2002 and change the structure of the
program in many significant ways. Nevertheless, more fundamental
changes will be required if Medicare is to cope successfully with the
retirement of the baby boom generation and the continued escalation
of health care costs.
These changes will be the focus of the seventeen-member National
Commission on the Future of Medicare that was established by the
Balanced Budget Act. This volume and the other reports of the
Academy's Restructuring Medicare for the Long Term project are
intended to provide useful information for the commission and
policymakers as they consider how best to restructure and strengthen
Medicare for the long term.
Those who presented papers and spoke at the conference were chosen
for their expertise and with eye to providing different disciplinary and
ideological
Page vi
perspectives on the problems. Given time constraints and other
commitments, not all were able to transform their remarks into a form
suitable for publication. Those that are contained in this volume
reflect the views of the authors and do not necessarily reflect those of
the officers, board, staff, or members of the Academy nor its funders.
The Academy does, however, assume responsibility for ensuring the
independence of this volume.
The Robert Wood Johnson Foundation, the Henry J. Kaiser Family
Foundation, The Pew Charitable Trusts, and the Kaiser Permanente
Foundation provided generous support for the conference.
The editors thank the conference participants for lively discussion and
debate. We also gratefully acknowledge Pamela J. Larson, Terry T.
Nixon and the Academy staff for their smooth and skillful
management of the conference. In addition to their work on the
conference, Michael E. Gluck and Dwayne L. Smith are thanked for
the significant contribution they have made to help transform the
conference proceedings into this volume.
We appreciate the efforts of Jim Schneider, who edited the
manuscript, and the rest of the staff of the Brookings Institution Press.
The book was proofread by Ellen Garshick and indexed by Mary
Mortenson.
ROBERT D. REISCHAUER
STUART BUTLER
JUDITH R. LAVE
Page vii
Contents
1. Introduction 1
Karen Matherlee
2. Medicare's Social Contract 15
The Contract and Medicare Reform 15
Stuart Butler
Pundits, People, and Medicare Reform 19
Theda Skocpol
Reflections on How Medicare Came About 27
Robert M. Ball
Social Insurance Commentary 38
E. J. Dionne
3. Financing Medicare 43
Preparing for the Retirement of the Baby Boomers 43
Joseph R. Antos
Comment by Charles Kahn III 52
Comment by Judith Feder 54
Comment by David B. Kendall 56

Page viii
4. Building a Sound Infrastructure for Choice 61
The Medicare Beneficiary as Consumer 61
Stan Jones
Structuring Choice under Medicare 75
Roger Feldman and Bryan Dowd
Restructuring Medicare: The Role of Public and Private 124
Purchasing Alliances
James C. Robinson and Patricia E. Powers
Carve-outs for Medicare: Possible Benefits and Risks 152
Melinda Beeuwkes Buntin and David Blumenthal
5. Fee-for-Service Medicare in a Managed Care World 185
The Medicare Fee-for-Service System: Applying 185
Managed Care Techniques
Peter D. Fox
Organizational Models for Restructuring Fee-for-Service 207
Medicare
David G. Smith
Comment by Alan Nelson 249
Comment by Kathy Buto 253
Comment by Thomas Scully 257
6. Leadership and Politics: Four Views 261
Anthony Beilenson 261