Medicare reform? Don't hold your breath

Today's USA Today has a good article on the coming Medicare budget crunch, pointing out the magnitude of the problem and the lack of political will to deal with it.

The steps Congress could take now to restrain Medicare's growth are politically perilous. Deny end-of-life care? Restrict eligibility? Reduce treatments? Raise costs? No one in Congress is willing to take them on, and there are few options the public might accept.

"Social Security is merely the warm-up for a very big struggle over how to reform Medicare," says Maya MacGuineas, president of the Committee for a Responsible Federal Budget. She laments that while the Social Security debate is in full throttle among policymakers, Medicare "is a discussion we haven't even started."

The article outlines a number of ideas that have been suggested, pointing out that not only would these steps be insufficient to restrain costs, they would also be unacceptable politically (for now).

• Reducing payments to providers --this has been tried but is usually reversed
• Increasing out of pocket expenses for seniors --unaffordable for many
• Reducing the scope of coverage --but we seem to be going the other way with the drug benefit and coverage for expensive treatments such as PET scans for Alzheimer's
• Raise the eligibility age --but again we are heading in the opposite direction, with pressure to allow younger people into the program
• Improve efficiency --by using technology. But this won't reduce costs, only open up capacity for more billing