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...inadequate that nonetheless siphons off increasingly limited funds that could be used to broaden coverage for children and working families.
The White House-backed Medicare reforms passed late last year only confirmed each side's worst fears, promising a meager and ill-designed drug benefit at a hugely inflated price. While millions go without basic coverage and budget deficits explode, critics asked how we can countenance pouring hundreds of billions of dollars into a system for the aged that already provides pretty decent protection.
Here's how: Make improvement and expansion of Medicare the route to universal health coverage in the United States. Medicare does badly need upgrading. Medicare does do too little to help the non-elderly. But the solution isn't to tear down Medicare; it's to build up the program to make it a stable foundation for providing health care for all Americans without access to good workplace coverage. In all the talk about skyrocketing health costs and the uninsured, everyone seems to have forgotten about the one program that can realistically get America to affordable universal insurance in the coming decades.
Ironically, the potential for expanding Medicare to all Americans owes much to past initiatives--mostly pursued by conservatives--that have enhanced beneficiaries' enrollment in private health plans. For all their shortcomings, these proposals have made it possible for Medicare to offer abroad array of private plans, as well as traditional fee-for-service insurance, to young and old alike. But this strategy will succeed only if Medicare also continues to provide the broad risk sharing that is vital to the program's long-standing success--and to the future of American health insurance.
FOR A PROGRAM SO LOVED BY THE PUBLIC THAT EVEN anti-government ideologues tread lightly around it, Medicare has come in for a surprisingly heavy critical barrage. The fusillade consists of two main volleys: that America can't afford Medicare and that the program is built on an irremediably antiquated model. Each of these claims is arresting and superficially attractive. Yet each is wrong, both in...
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