The Public and the Conflict over Future Medicare Spending

By Robert J. Blendon, Sc.D., and John M. Benson, M.A.
The New England Journal of Medicine, September 12, 2013

Our thesis is that there exists today a wide gap in beliefs between experts on the financial state of Medicare and the public at large. Because of the potential electoral consequences, these differences in perception are likely to have ramifications for policymakers addressing this issue.

There are concerns about Medicare today and current cost-containment efforts. Most respondents see Medicare in some cases already withholding treatments and prescription drugs to save money, including 63% who believe this happens very often or somewhat often. Also, the public sees the bigger problem for Medicare beneficiaries as not getting the health care they need (61%) rather than as receiving unnecessary care (21%). Medicare pays about half the total personal health care expenditures for beneficiaries, but many people are confused about what proportion is paid by Medicare, whether it pays for most of recipients’ bills or substantially less.

When given a dozen possible causes for rising Medicare costs that have been suggested either by experts or in the media, the majority do not identify any one of them as the most important. However, the three most often cited reasons relate to poor management of Medicare by government, fraud and abuse in the health sector, and excessive charges by hospitals. The lowest ranked reason was the cost of new drugs and treatments being offered to seniors.

Although Medicare is popular, it is not seen as better run than private insurance plans, nor is it seen as particularly different from private coverage with respect to quality of care or access to physician care.

The one area of clear support for the future is the growing preference for Medicare Advantage–type private health coverage among persons less than 65 years of age.

In conclusion, two points are important. 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. Until these concerns are better addressed, the gaps in perception are likely to remain.

Public Often Clueless About Medicare

By David Pittman
MedPage Today, September 11, 20133

Because of a high level of misunderstanding about Medicare’s financing, lawmakers in Congress are hesitant to enact changes to the program fearing voter backlash, Bob Blendon, ScD, and John Benson, MA, both of Harvard University, wrote in a special report in Wednesday’s New England Journal of Medicine.

Ted Marmor, PhD, professor emeritus of public policy at Yale University, said it’s misleading to imply public opinion is a shaper of public policy. He called it more of a protector than a promoter.

“The public is almost never well informed about details,” Marmor told MedPage Today in a video interview. “What’s important about public opinion is what its values are and what it would be threatened by, not what it means in terms of shaping public policy in terms of direction on details.”

Public Attitudes about Medicare

Harvard School of Public Health
Poll – May 13-26, 2013

10. Which do you think is better run, (the federal Medicare program) or (private health insurance plans that people get through their jobs), or do you think they are about equally well run?

15% – The federal Medicare program
41% – Private health insurance plans
39% – About equally well run
5% – Don’t know/ Refused

19. (When you retire,) If you had a choice, would you prefer to get your Medicare health insurance benefits from the current government Medicare program, or from a private health plan, such as a PPO or HMO, offered through Medicare?

34% – From the current government Medicare program
56% – From a private health plan, such as a PPO or HMO, offered through Medicare
10% – Don’t know/ Refused

The public is not well informed on the details of Medicare. A plurality believe that private insurance plans are better run than Medicare, and a majority would prefer private plans when they retire.,

We should think about the political implications of this. Is “Medicare for All” really a good slogan for single payer? Medicare has some very serious defects, like it pays only about half of beneficiaries’ health expenditures. Yet we certainly don’t want a slogan that would suggest that single payer would be like private insurance for everyone.

We shouldn’t change course based on the results of a single poll, but we should continue to think about how we can improve our messaging so that people do understand that single payer is what they really want. That’s true when the facts are presented, but too many still don’t understand that. As Ted Marmor implies, perhaps we should be placing more emphasis on values.