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Americans don't understand Medicare either

Posted by John McDonough  September 16, 2013 09:45 PM

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I recommend this article -- The Public and the Conflict over Future Medicare Spending -- by my HSPH colleague Bob Blendon and John Benson in last week's New England Journal of Medicine for a clear-eyed look at public attitudes about Medicare. It's not a pretty picture. Their thesis: "...there exists today a wide gap in beliefs between experts on the financial state of Medicare and the public at large." Let's boil it down to the essentials.

First, though the growth in Medicare spending has slowed dramatically during the past five years, and accelerating since passage of the Affordable Care Act/Obamacare, "the public is unaware of this." Fully 62% believe Medicare spending is rising faster than it was five years ago.  

Second, despite this erroneous pessimistic belief, few Americans (between 10 and 36%) support major Medicare reductions to reduce the federal deficit.

Third, only 53% of Americans realize that Medicare is one of the largest accounts in the U.S. federal budget, and only 31% see it as a major contributor to the federal deficit.

Fourth, though Medicare beneficiaries only pay $1 for every $3 they eventually receive in medical benefits through the program, fully two thirds believe Medicare beneficiaries only get back what they paid in during their working years.

Fifth, Medicare beneficiaries are more worried about not getting the care they need (61%) than they are about receiving unnecessary care (21%).

Sixth, good news at last! 74% of Americans recognize that Medicare is a federal government program. What do the other 26% think?

Seventh, when asked why Medicare costs are rising, the most often cited answers were: 1. Poor management by the government (30%); 2. Fraud and abuse (24%); and 3. Excessive charges by hospitals (23%).

Eighth, much pessimism exists about Medicare's future: 38% believe that 15 years from now, the program will pay for a lower level of benefits than currently, and 32% believe it will no longer exist, while 39% say is will probably not be there when they need it, and a majority believe the program will likely withhold drugs, care, or surgical treatments from those who need it.

Ninth, and not good news for "accountable care," 65% say they favor "fee for service" versus 30% who prefer capitated arrangements, today referred to as "global payments." But here's a confounder: "When you retire, if you had a choice, would you prefer to get your Medicare health insurance benefits from:"

The current government Medicare program? 34%
A private health plan, such as a PPO or HMO through Medicare? 56%

The only variation in the responses were from those 65+: 57 vs. 29%.

Finally, "how important for you and your family is Medicare?"

Very or somewhat important: 77% -- among seniors, 93%
Not too or not at all important: 22% -- among seniors, 5%

The authors conclude with two points.

"It would aid the long-term resolution of these issues if there were a nonpartisan, broad-based public education campaign launched focusing on how Medicare works financially. Second, it would be advantageous if discussions of the financial sustainability of Medicare could be separated from public debates over reducing budget deficits or enacting tax cuts."

People ask me all the time why the public is so confused about the ACA. One of my responses is that the public is confused about our entire health care system. If you do not understand our health care system, how can you understand reform of it? And if you are confused about Medicare to begin with, how can you understand its reform?

The one unshakable truth from the survey -- Medicare matters a lot to all Americans, and especially to our senior citizens.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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