Challenges in Medicare Reform in the United States

Medicare, enacted in 1965 along with Medicaid, a distinct program for the poor, was the political precipitate of the national health insurance model of which reformers had long dreamed in vain. The program gave new coverage to the elderly (and later, in 1972, to the disabled). Its benefits included hospital care and physician services, but not outpatient prescription drugs and long term care. This paper has three elements. First, it briefly sketches the background and basic features of Medicare. Second, it quickly reviews current reform debates in three policy arenas– payment, coverage, and funding. Finally, it sets Medicare in the context of debates, resurfacing in 2008 as national elections draw near, about health reform in the larger US system and highlights some links between these US challenges and those in other systems