The prescription drug benefit has generated tremendous controversy, according to William Custer, Associate Professor with the Institute of Health Administration and Director of the Center for Health Services Research. When the bill was passed in 2003, Medicare already faced a $15 to $20 trillion unfunded obligation and this added another $8 trillion.
“We have made promises in the Medicare program that we haven’t funded. And we are not sure of the scope of those funding issues in the future. So, essentially we are borrowing money from future generations to pay for current healthcare and for future healthcare. The Medicare program is putting out more money than it is taking in at the moment. And Medicare is actually a fairly limited program. Clearly, the elderly are better off with it than they would have been without it, but it is not nearly as generous as a standard employer’s plan. I think the most recent statistic that I saw is that 88 percent of Medicare beneficiaries have some type of supplemental coverage.”
He says the solutions to the Medicare problem are complex. A key factor has simply been the rising costs of healthcare, which, he says, are only going to continue to go up for the foreseeable future. However, few Americans would support reducing research to save money. The benefits – and the needs – are simply too great. “But I think that most Americans believe there is a great deal of waste in the healthcare system and that we are not getting a full return on our investment,” says Custer. “So I think the political process is going to work out over the next decade to where we have a very different healthcare financing system. The direction of that change is something that is still up in the air.”
The problem is highly complex with no clear-cut solution. But Custer says that improved information systems are key.
“Right now we have a very mixed system in the United States, with very different incentives for providers and consumers. We don’t have anything close to uniformity and of course most people would argue, we don’t want to have uniformity. You don’t want to have a single breakfast cereal, and you don’t want to have a single insurance plan. But we don’t have good information systems for identifying what appropriate care should be.
There has been an effort at the federal level and by private
entities to create new and more efficient information systems. But we are not
there yet,” says Custer
|
