Medicare's Midlife Crisis by Sue A. Blevins
Sue A. Blevins' new book is to the health policy debate what Thomas Sowell's The Vision of the Anointed is to the social policy debate. The history of Medicare follows a pattern similar to other Progressive initiatives. It was a solution to a problem that did not exist. Contrary to liberal think-tank folklore, Blevins argues that the availability of health care to seniors had been on the rise, long before Medicare was adopted in 1965. In the course of offering a solution to a non-existent crisis, Medicare created a new set of very real problems: skyrocketing costs, invasions of privacy, and interference in the doctor-patient relationship, to name a few.
Blevins paints a bleak picture of Medicare's demographic realities, noting that the Congressional Budget Office "points out that the number of beneficiaries in 2030 will be 90 percent greater than it is today, but the number of workers supporting Medicare will be only about 15 percent greater." The Medicare system is stretched to the limit. Any new additions, such as a prescription drug benefit, will likely push the system past the actuarial breaking point.
The Sisyphean cycle of Medicare-big government solutions creating problems that require big government solutions—can be broken, Blevins argues, by adopting something akin to President Bush's proposed Social Security savings account plan. A worker under such a plan could, upon retirement, purchase health coverage from a private insurer at a cost savings of 50 percent when compared to the current Medicare plan.
The sheer size of the looming Medicare financial crisis will continue to spawn a variety of proposed solutions. Blevins' preferred option is not the first or last word on this matter. But her analysis is indispensable.
—Brian P. Janiskee
California State University, San Bernardino
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This article appeared in the Winter 2002 issue of the Claremont Review of Books