Although Americans see Medicare as a key part of the country's social contract and want to preserve it in some recognizable form, they are willing to consider significant changes in the program to hold down its costs as the U.S. population ages.
In day-long “Choice-Dialogues” in which Americans from all walks of life considered the pros and cons of a range of choices for reforming Medicare, common ground was found in several key areas:
• Allow Medicare to negotiate prices for prescription drugs (94 percent support).
• Encourage hospice care instead of heroic end-of-life measures (85 percent support).
• Only cover treatments that are scientifically proven to be effective (68 percent support).
• Emphasize preventive care and personal responsibility (89 percent consider preventive care very important or essential).
• Gradually increase the Medicare eligibility age from 65 to 67 (68 percent support).
If additional money is needed to maintain Medicare in a way that is familiar in the future, Americans would rather see the government raise taxes than increase the federal debt.
These are among the central findings in the report entitled “Medicare: It’s Not Just Another Program,” by The Concord Coalition and Viewpoint Learning. The report also underscores public dismay at the health care system in general. It comes as Congress and the Obama administration are working on massive changes in the entire system.
“Participants repeatedly expressed concerns over what they saw as a Byzantine and unaccountable health care system,” the Medicare report says. “Most felt that the medical industry (especially the pharmaceutical companies) puts profits before people.”
Robert L. Bixby, executive director of The Concord Coalition, says the report shows that Americans are prepared to accept significant changes in the program that plays a central role in the federal government’s long-term fiscal problems.
“Medicare is on an unsustainable path and must be reformed,” Bixby said. “According to conventional wisdom, however, the public is not ready to accept any change in the status quo. The good news from these Choice-Dialogues is that the conventional wisdom is wrong; the public is ready and willing to consider some very fundamental Medicare reforms so long as the program is preserved as a vital part of the social contract.”
“Politicians who are truly interested in saving Medicare should stop the scare tactics and start engaging the public in a dialogue on the real trade-offs that must be confronted,” Bixby added. “Changes will still be difficult, but the results will be more acceptable.”
Viewpoint Learning conducted the dialogues with randomly selected representative samples of 35-40 citizens in Oak Brook, Illinois; Columbia Maryland; Phoenix and Houston. This project builds on the findings of a broader two-year project, “The America We Want,” that examined public opinion on a broader range of federal programs and budget issues.
The new report found that many Americans lacked a strong understanding of the Medicare program, how it is funded, and the severity of the fiscal challenges facing the United States in the years ahead.
Yet most participants in the dialogues, after studying these issues in depth and spending much of a day discussing the problems and possible solutions with others, were able to agree on a set of Medicare changes.
But to win public support, the report cautions, “proposals for major reform to Medicare need to recognize the extent to which Americans see Medicare as an essential part of the social contract and not just as another government program.”
Steven Rosell, president of Viewpoint Learning, said “The findings from these daylong dialogues with Americans from very different backgrounds and perspectives reveal deep disconnects between how Washington talks about Medicare and health care reform and how the public talks about them. In case after case, the report shows how leaders and the public are talking past each other, and how this deep disconnect and misunderstanding lead to the heat and the rancor that have made advancing real reform so difficult.”
When most people talk about the “cost of health care,” for example, they are focused on what they pay in premiums, co-pays and drug expenses. When health care experts talk about costs, however, they usually focus on the costs to businesses, government and other institutions.
Rosell also noted that many Americans do not realize that they are essentially paying for the cost of care for the uninsured already.
The new report, he said, provides insight for leaders about how best to bridge such disconnects and begin to create a learning curve that could lead to public support for significant Medicare reform.
Some elements in the new report also echo the findings of The Concord Coalition’s fiscal advisory councils that met in early December in Washington. Working in six different parts of the country on Concord’s Fiscal Stewardship Project, these advisory councils called for sweeping reforms in the health care system and some changes in Medicare to put the government on a more sustainable fiscal path. More information on the advisory councils’ work is available at