Panel outlines path to Medicare reform

Four panelists, including New York Times columnist David Brooks, right, debated the merits of public versus private healthcare on Tuesday.
Four panelists, including New York Times columnist David Brooks, right, debated the merits of public versus private healthcare on Tuesday. Photo by Kathryn Crandall.

Four panelists who met Tuesday afternoon to discuss the future of Medicare agreed that the system is currently unsustainable and offered suggestions on how to improve the program.

New York Times columnist David Brooks, assistant professor of public health and economics Zack Cooper, Director of the Yale Institution for Social and Policy Studies Jacob Hacker GRD ’00 and former Director of the Center for Medicare and Medicaid Services Thomas Scully explained to a packed audience in the Woolsey Hall President’s Room and to viewers who watched the live YouTube broadcast that Medicare as it is will not last in the long-run because of increased enrollment. The panelists debated the merits of public versus private healthcare as well as what the role of government should be in regulating the healthcare market.

“Medicare is taking up too much federal revenue, and government has become a machine taking money from struggling families and giving it to affluent elderly couples,” Brooks said.

Brooks said the fundamental problem with Medicare is the incentive programs that allow people on average to pay less during their careers than they take out after they reach retirement age. He added that he thinks the size of the program should be reduced.

Scully said he sees the real problem as an issue of private versus public health insurance. During his time as director of CMS, he designed Medicare Part D, the prescription drug benefit of Medicare that is an entirely private system with no government involvement, which he said has proven to be a successful model.

He added that since price-fixing by the government has never worked, the goal in Medicare reform should be to “get to the point where people are buying well-regulated, private healthcare.”

Disagreeing with Scully, Hacker said private health insurance plans are more costly than public ones, adding that there is no evidence that private plans are more effective. The prognosis on the sustainability of Medicare is “a little too pessimistic,” he added, since the growth of its costs has been slowing.

“If we value Medicare, as I think we should, we’re going to spend more money on it and figure out a way to finance it,” Hacker said.

Rather than privatizing Medicare, Hacker said, lawmakers should consider other ways to reform the system to make it sustainable. He said he “sees real merit in an enforceable budget and consumption taxes” and that the Medicare program could save money by using certain medical devices and generic drugs.

Still, Cooper said trust in the government is currently low, which is why any regulations coming from the government meet public resistance. While he said he supports government intervention “to make a competitive market function,” people are now rallying against government interference.

All four panelists agreed that polarization in Washington poses an obstacle to healthcare reform. But Hacker said Americans should recognize that some forward progress has been made. Accelerating reform will require changing the battle between the right and the left into a discussion focused on longer-term challenges, he added.

Members of the audience said they saw little consensus in the room about the path to Medicare reform and that the tension mirrored the difficulties Congress faces in passing meaningful healthcare legislation.

Bill Sage, a professor at the University of Texas Law School, said he was frustrated that in all the debate on healthcare, the panelists “didn’t say a word about health” or the goal to actually improve health under various insurance policies.

Romana James, a member of the New Haven community, said despite presenting starkly different viewpoints, she thinks that the panelists showed they have the same goal in mind.

“I appreciated that they showed some optimism and didn’t make healthcare reform into a dark cloud — what we really need are more moderates,” she said.

The panel was moderated by Sarah Kliff, a health policy reporter for The Washington Post.

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