Robert D. Reischauer - Medicare: Preparing for the Challenges of the 21st Century (Conference of the National Academy of Social Insurance)
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Medicare: Preparing for the Challenges of the 21st Century (Conference of the National Academy of Social Insurance)
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In this cross-cutting analysis, some of the nations most prominent social insurance experts go beyond recent budget debates to examine the fundamental and technical choices Medicare poses for the American people in the next century. The book begins with a consideration of the underlying social contract between Medicares beneficiaries and workers. Pointing out that Medicare historically has had particular significance for civil rights and womens economic security in addition to providing health security, the authors debate the appropriate social contract for the future. The book also lays out the challenges in financing Medicare as health care costs rise and the population ages.Several authors explore how the growth in managed care is likely to affect Medicare beneficiaries with particular emphasis on beneficiaries with chronic illness, and they address some of the policy changes needed to make managed care better. In addition, they also look at how managed-care tools could be applied to the fee-for-service sector. The book concludes with an examination of how public opinion, politics, and leadership affect the prospects for significant Medicare restructuring in the near and long term.
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All rights reserved. No part of this publication may be reproduced or transmitted in any means without permission in writing from the Brookings Institution Press.
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 368.4'26'00973dc2197-33931
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
Typeset in Palatino
Composition by AlphaWebTech Mechanicsville, Maryland
Printed by Kirby Lithographic Co. Arlington, Virginia
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
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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.
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