In July 2008, 68-year-old Mr. S appeared on the doorstep of his longtime friend, Virginia, carrying a garbage bag that contained everything he owned. Despite the fact that he lived just a few miles away, Virginia hadn’t seen him in well over a year. She invited him inside. In halting, labored speech, he told her about having been abused and financially exploited by a woman he’d met in a bar months earlier.
Generations Guest Editors Tricia Neuman and John Rother devised and posed the questions in this discussion between Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy of the American Enterprise Institute in Washington, D.C., and Thomas Rice, Distinguished Professor of the UCLA Fielding School of Public Health’s Department of Health Policy and Management in Los Angeles, California.
Few issues have flummoxed policy makers more than how to address the need to improve coverage of long-term-care services and supports (LTSS). Two leading experts, Sheila Burke, adjunct lecturer and faculty research fellow at the Malcolm Weiner Center for Social Policy at the Harvard Kennedy School, in Cambridge, Massachusetts, and Judith Feder, founding dean and professor at the Georgetown University McCourt School of Public Policy and Institute Fellow at the Urban Institute, both in Washington, D.C., provide their perspectives on the role Medicare can play.
This roundtable offers perspectives from two former Medicare administrators, Bruce Vladeck, who is currently a senior advisor for the healthcare consulting firm Nexera, Inc., in New York City, and Gail Wilensky, who is an economist and senior fellow at Project HOPE, an international health foundation in Washington, D.C. What are their frustrations with Medicare and what are their prescriptions for improvement? Generations Guest Editors Tricia Neuman and John Rother moderated this discussion.
Medicare was born of interest group politics. The hostility of the American Medical Association (AMA)—the fiercest lobby in Washington from the 1930s to the 1960s—convinced advocates of public health insurance to start with the most vulnerable and difficult-to-insure segment of the population, the elderly. It also convinced Medicare’s advocates and early administrators to foreswear serious instruments for cost control that were in use in other rich democracies, such as fee schedules and restrictions on capital expenditures.
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