Rethinking Medicare Reform
Theodore R. Marmor
Yale School of Management
University of North Carolina (UNC) at Chapel Hill - Department of Social Medicine
Health Affairs, Vol. 17, No. 1, Jan/Feb 1998
Many health policy analysts argue that demographic pressures, the inflationary nature of fee-for-service payment, and the uncontrollable nature of defined-benefit insurance make Medicare unsustainable in its current form. They assert that Medicare can remain fiscally viable in the next century only by embracing a voucher system and exposing beneficiaries to the economic consequences of their medical care decisions. We argue here, however that Medicare need not rely on vouchers or on placing financial incentives on individual beneficiaries to control costs. Instead, we contend that Medicare can control expenditures the way most other industrial democracies do: through budgetary caps and centralized regulation of provider payments.
Date posted: September 27, 1999