HEALTHCARE
October 10, 2013

Is Medicare A Benefit or Right?

Medicare is running out of money. Experts say benefits are misused; consumers see it quite differently. That's the rub.

Experts and the public continue to disagree about the future of Medicare. In fact, based on a report just published in the New England Journal of Medicine, they might as well be speaking two different languages.

The Medicare Trust Fund is expected to run out of funds in 2026. And as the third largest item in the federal budget, Medicare is a significant contributor to the national debt. These two reasons lead many experts to say that Medicare spending will soon need to be cut, with unnecessary care being a prime target.

The public, however, sees the problem very differently.

The report's authors think that much of the public's position may come from people not having their facts straight.

Six polls taken in 2013 show a distinct lack of public support for such cuts, however. Two findings are most striking: By a nearly 3 to 1 margin, the public feels that not getting the health care they need is more of a problem for Medicare recipients (61%) than getting unnecessary care is (21%). And when asked about a Congressional candidate who supports major cuts in Medicare to reduce the federal budget deficit, 58% said they'd be less likely to vote for that candidate, while only 12% said they'd more likely to vote for them.

When asked specifically about cutting future Medicare spending, people's answers depended on the exact wording of the question. If the cuts were to reduce the federal deficit or pay for an income tax cut, people were strongly opposed. But if cuts were needed to improve the long-term financial position of the Medicare program, they were supportive: 67% were in favor and only 29% opposed.

The report's authors think that much of the public's position may come from people not having their facts straight. Most people believe that Medicare recipients pay or prepay the cost of their health care, when they actually pay about $1 for every $3 of health care they receive. And only 31% of the public believes that Medicare spending is a major cause of the deficit.

Of course, it's possible that the public looks at health care from an entirely different perspective from the experts, seeing it as a basic human right, not as a commodity to be paid for.

“These differences in perspective between Medicare experts and the public are likely to make this issue much more difficult for the President and Congress to address,” Robert Blendon, professor of health policy and political analysis at Harvard School of Public Health and co-author of the analysis said in a statement.

The opposition to cuts may simply be an expression of a different way of viewing health care — is it a benefit or a right? While the U.S. Constitution has no provision that guarantees a right to public health or health care, over half of the world's countries do: 73 countries guarantee the right to medical care services. But it would take another poll to find out if this is actually the public's viewpoint — the six polls didn't ask this information.

The report's authors suggest that a public education campaign explaining how Medicare works financially and separating discussions of the financial health of Medicare from discussions of the federal budget deficit would be helpful both in solving Medicare's problems and in bringing the public's perceptions more in line with those of the experts.

The report was funded by the Robert Wood Johnson Foundation and appears in the New England Journal of Medicine. It is freely available.

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