August 2012 Archives

Musings about Medicare

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I love this time of year at the university. As much as I enjoy the casual, productive research time of summer, it is always energizing when the students arrive on campus. This academic year is my seventh since moving to the School of Public Health. A lot has changed in that time --marriage, baby, year in Washington DC, new home, and tenure and promotion.

As someone who researches and teaches in the area of health economics and policy, it is an exciting time! Change has been dramatic in terms of health care delivery and financing too, given passage of the Affordable Care Act in March 2010 and it being upheld by the Supreme Court in June.

Of course, now we look forward to the November election and with it renewed discussions about one of our "other" major health policy issues - Medicare. As I commented to a reporter not too long ago, the answers are not as obvious to economists about Medicare reform. We know that the program is fiscally unsustainable and so major changes need to happen in order to preserve it. Even as a moderate, I find some appeal in the idea of Ryan's plan, although I think that real reform is going to need to draw on both the demand-side and supply-side vis-a-vis payment reforms to hospitals, physicians, and other providers.

So much discussion and education needs to occur regarding the facts about Medicare as well as what we as a society can and cannot afford today and in the future.

After my time in Washington, I have little faith in Congress' ability to tackle this issue with any policy significant enough to make a real difference. I understand the interplay of policy and politics. I saw it occur in the White House every single day. The first rule of thumb held by many politicians -- do no harm to you or your constituents. That, I'm afraid is going to make it very challenging to change the trajectory of Medicare spending and its implications for the allocation of resources to other programs and population segments.

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