Lessons from Medicare for Health Care Reform

SOURCE: AP/L.M. Otero

Medicare and it's programs, such as the prescription drug benefit, provide many lessons, both positive and negative, for crafting a reformed health care system.

By Marilyn Moon | April 2, 2009

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Medicare has operated successfully for over 40 years by offering essentially universal coverage to people 65 and over. The program covers some of the sickest and frailest of the U.S. population, along with a substantial number of disabled Americans. While Medicare provides an example of a universal, public health insurance program, health care reform will likely take the form of a system offering the choice of multiple private—and perhaps a public—health insurance plans.

Nonetheless, Medicare’s experience offers a number of key lessons—both positive and negative—that can help in the development of affordable health coverage for all Americans.

The following lessons can help inform the creation of health reforms that learn from and build upon Medicare’s successes and failures.

• A standard benefit package should be sufficiently comprehensive to enable enrollees to forego supplemental coverage. If supplemental coverage is available, it should “wrap around” the standard package.
• Premium and cost-sharing subsidies should be easy to obtain and sufficient to provide meaningful financial protection. Administrative barriers to enrollment and unduly restrictive eligibility rules ultimately limit access to coverage.
• A commitment to choice, particularly choice of health plans, requires a commitment to regulation and oversight—specifically, reasonable rules for plan marketing efforts, an investment in consumer information, and an appropriate degree of standardization (and therefore comparability) across plans.
• Strong data reporting requirements for health plans will strengthen our understanding of key dynamics within the health care system.
• Consumers need help in navigating the health care system and in understanding how better information can help in decision making.
• Increased attention to innovation within public programs, supported by investment in research on what works, can lead the entire system toward greater efficiency and quality.
• Flexibility should be encouraged within appropriate boundaries. Private and public plans should have the ability to develop innovative payment systems and other improvements, but not at the expense of providers’ and patients’ rights.

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