Medicare

Building on the American Recovery and Reinvestment Act of 2009, health reform legislation would develop an infrastructure for the ongoing generation and dissemination of information on the comparative effectiveness, where "comparative effectiveness" has been defined as the study of methods to prevent, diagnoses, treat, and monitor A clinical condition or improve delivery of care to assist consumers, clinicians, purchasers, and policy makers to make informed decisions to improve health care at both individual and population levels. The issue brief explores the concept and describes areas of controversy that need to be addressed to make comparative effectiveness research successful.

It’s not exactly news — to Congress, the White House, and now many outside of elite circles — that the federal budget is out of control. Social Security, Medicare, and Medicaid make up more than 40 percent of spending other than interest during a normal year and all are growing faster than the economy and tax revenues. Yet, Congress has kept the overall tax burden remarkably constant as a share of gross domestic product for most of the past 50 years. Together, these factors lead to sky-high deficits, an exploding national debt, and the specter of economic collapse.

Rising health care costs threaten boomers' retirement security. In 2040, half of adults age 65 and older will spend at least 19 percent of their incomes on health care, up from 10 percent in 2010, if costs grow at the intermediate rate projected by the Medicare trustees. About 7 in 10 older Americans in the bottom two-fifths of the income distribution will spend more than 20 percent of their incomes on health care in 2040. These projections underscore the importance of controlling health care costs and the need for boomers to plan for future health care spending.

Institute Fellow Rudy Penner describes how the U.S. budget is prepared by the executive branch and Congress, and how it then is implemented by the executive branch. The budget preparation process could be improved, Penner asserts, but budget implementation works smoothly and efficiently. The severe long-run budget problem the country faces is caused by only three spending programs: Social Security, Medicare, and Medicaid. All are growing faster than the economy, and there is strong opposition against raising tax burdens. Changes are suggested for the budget process so that it is better suited for dealing with this long-run problem.

In his State of the Union address, President Obama no doubt will promise to attack the deficit. Trouble is, the deficit is only a symptom of a chronic disease that strikes at the very heart of democratic government. The disease? Fiscal sclerosis — setting future national priorities in stone long before the future has arrived. Our fiscal arteries are so clogged and hardened that to do anything new, meet any emergency, or engage any new opportunity, the president must renege on past legislators' promises. If he doesn't address unsustainable promises head on, government will be tied up with yesterday's problems and the demands of yesterday's voters.