Heading in the wrong direction on Medicare

Older Americans Were Sicker And Faced More Financial Barriers To Health Care Than Counterparts In Other Countries

By Robin Osborn, Michelle M. Doty, Donald Moulds, Dana O. Sarnak, and Arnav Shah
Health Affairs, November 15, 2017


High-income countries are grappling with the challenge of caring for aging populations, many of whose members have chronic illnesses and declining capacity to manage activities of daily living. The 2017 Commonwealth Fund International Health Policy Survey of Older Adults in eleven countries showed that US seniors were sicker than their counterparts in other countries and, despite universal coverage under Medicare, faced more financial barriers to health care. The survey’s findings also highlight economic hardship and mental health problems that may affect older adults’ health, use of care, and outcomes. They show that in some countries, one in five elderly people have unmet needs for social care services — a gap that can undermine health. New to the survey is a focus on the “high-need” elderly (those with multiple chronic conditions or functional limitations), who reported high rates of emergency department use and care coordination failures. Across all eleven countries, many high-need elderly people expressed dissatisfaction with the quality of health care they had received.

From the Discussion

The elderly US population is already sicker than similar populations in other countries. Part of the cause is likely to be gaps in coverage and preventive care during Americans’ working years, which results in an older population that ages into Medicare with unmanaged chronic illness.

The US elderly face a “triple whammy,” as they experience higher cost sharing, higher levels of economic vulnerability, and dramatically higher health care costs — with prescription drugs often two or three times as expensive in the United States as in the other countries studied.

The Social Safety Net

The economic vulnerability of older adults emerged from this study as a key concern. Research shows that poverty, food insecurity, unstable housing, social isolation, and mental health problems contribute to higher rates of chronic illness, poorer health and outcomes, higher utilization of the health care system, and greater costs. The United States stands out for disproportionately low spending on social care services compared to health. A previous analysis has shown that some countries in the Organization for Economic Cooperation and Development spend, on average, two dollars on social services for every one dollar on health care. In the United States, less than sixty cents is spent on social services for every health care dollar spent.


First, Republicans want tax cuts. Next, they’ll try gutting Medicare and Social Security.

By Bruce Bartlett
The Washington Post, November 16, 2017

For decades, conservative intellectuals have pushed for big tax cuts; less to grow the economy and more because they want to “starve the beast.” They want to force a major overall spending cut that would be a political non-starter without first passing a tax cut that creates a deficit so large, something must be done about it. Spending cuts must be enacted, then, as they would be presented as the only way to pay for the already passed tax cut’s lost revenue.

Once we can see the whole picture, Americans will have a clearer idea of the net benefit to them. The rich don’t need either Social Security or Medicare — it’s the middle class, which depends on both, that needs to know how tax cuts and spending cuts affect them. If Social Security and Medicare cuts follow tax cuts, on net, even those who would get a tiny tax cut will be much worse off when the spending cuts are factored in. This will give a true, complete picture of the distribution of pain and gain in the GOP program.



By Don McCanne, M.D.

Medicare beneficiaries are sicker and face more financial barriers to care than do the elderly in other wealthy nations. Further, the U.S. spends far less proportionately on social services. Clearly we need to do more.

So where is Congress headed? At a time that we have intolerable levels of transfer of income and wealth to the very top, Congress is going to decrease taxes for the very wealthy which will only increase that dastardly transfer. The budget deficits that will be created will supposedly prove that the federal government will no longer be able to afford Social Security and Medicare and thus it will be necessary to slash their budgets as the systems are privatized.

Where we should be headed instead is that we need to improve the Medicare program and then expand it to cover everyone. Since too much income and wealth is at the top we need to increase taxes on that sector rather than reduce them. This is the opposite of what we are witnessing right now. Where is the outrage?

Stay informed! Visit to sign up for daily email updates.