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TOP JOBS

If it’s so clearly time to deal with the Medicare crisis, why does Congress keep hitting the snooze button?

“The periodic ritual of announcing the mounting size of the fiscal problem posed by Medicare has never been, and will never be, enough to generate productive reform,” says Thomas Miller of the American Enterprise Institute. “Most of us got the memo that we are overcommitted and underfunded. Merely pointing to the size of the problem — in terms of Medicare’s massive unfunded long-term liabilities, near-term budget imbalances, future rates of taxation that will be needed to sustain the program, or Medicare’s preemption of national resources that crowds out funding for other important public programs and private activities — has had little effect.”

There’s plenty of talk, but little action.

“There is no shortage of reform ideas and proposals that are interesting and potentially promising, though difficult to prove workable while they stay on the policy shelves,” Miller says. “The issue is that our political officeholders and even those portions of the voting public that are at least partly aware of the problems do not really want to deal with them — at least not until the more visible consequences of what some of us rail against actually become tangible, immediate, and inescapable. At that point, most of the remaining options to fix the program will be even more unpleasant than the ones we resist or avoid today, and it will be time to load into an inadequate supply of political life rafts.”

But action must begin now, he contends.

“We need to get started as soon as possible on many fronts, in ways that may not seem transformative but still would be somewhat useful today,” Miller says. “What we do not need is another round of ‘national conversations. Remember how well that worked for Social Security reform? We need much more than modest budget process changes that make it slightly more difficult to once again avert our eyes from what we would rather leave until another day.”

But Miller adds that the doomsayers are not only ineffective in spurring action, they’re also probably wrong.

“I am optimistic for three basic reasons that in the long run Medicare, our health care system, and our fiscal balance sheets will improve,” Miller says. “First, they have to, because we will eventually run out of money. Second, we have already tried most of the wrong or illusory solutions to Medicare’s long-term problems. There may be a few more of those left, but it is getting harder to avoid accidentally pulling out the overlooked effective ones still waiting at the bottom of the political barrel. Third, at the end of the day, most Americans will grow increasingly dissatisfied with an expensive health care system, led by Medicare, that not only does not deliver enough value for money, but also falls short of rising expectations year after year.”

Fixing Medicare isn’t a particularly complicated proposal, Miller says.

“There are three generic solutions to Medicare’s fiscal sustainability problems: lower its costs (pay less to providers, cover fewer benefits, and leave more expenses to beneficiaries); increase the program’s income (higher taxes, higher beneficiary premiums); and improve Medicare’s efficiency (better value in terms of lower all-in-costs for treating and managing particular episodes of care to produce a desired level of health outcomes),” he says.

A combination of all three will be needed.

Declarations of impending doom won’t produce action on the part of Congress. National discussions are redundant and have produced little fruit. It’s time for Congress to wake up to and do something.