What's the Future for Medicare?

Symposium on Medicare reform

In 1999, the American Economic Association conducted a symposium on Medicare reform.

The American Economic Association, based at Vanderbilt University in Nashville, Tenn., is a not-for-profit scholarly organization that promotes economic research.

Medicare spending is expected to increase substantially in the absence of reform. According to estimates from the Congressional Budget Office and the U.S. Health Care Financing Administration, Medicare spending in 1999 accounted for about 12 percent of the federal budget and could increase to as much as one-third of the federal budget by 2030.

Concern about the long-term stability and quality of Medicare, debate over the use of projected federal budget surpluses, and dissatisfaction with major Medicare reform legislation recent at the time—which proposed to reduce regulated fees for provider services—all contributed to interest in reform when this grant got funded.

The grantee organization proposed this conference during a time of legislative activity regarding Medicare reform.

The symposium grew out of the development of five papers—economic analyses of Medicare reform—that were being prepared for an issue of the Journal of Economic Perspectives, a peer-reviewed journal of the American Economic Association.

Through a symposium, the editors aimed to reach a broader audience of the public, the policy community and the press. Alan Krueger, professor of economics at Princeton University and editor of the journal, directed the project.

Key Results:

  • The "Symposium on the Future of Medicare" took place on Oct. 15, 1999, at the National Press Club in Washington.

    Approximately 50 people attended the symposium, including policy analysts from both the legislative and executive branches of the federal government; academic economists; interest groups related to health, the elderly and organized labor; and journalists.

    Presentations were given by the authors of the papers, including:
    • Mark McClellan, "Medicare Reform: Fundamental Problems, Incremental Steps"
    • David M. Cutler, "Walking the Tightrope on Medicare Reform"
    • Victor R. Fuchs, "Medicare Reform: The Larger Picture"
    • Uwe E. Reinhardt, "Health Care for the Aging Baby Boom: Lessons From Abroad"
    • Thomas R. Saving, "On Making the Transition to Prepaid Medicare"
    Each speaker provided in-kind support for the symposium by forgoing the usual honorarium for such work, estimated at $2,000–$6,000 per speaker.

The grantee organization reported that the audience represented the various groups the project hoped to reach but amounted to about half the number anticipated. The lower turnout was attributed partly to an article in The Washington Post the day before the symposium, in which Medicare reform had been pronounced dead.

The project director reported two results of the symposium:

  • Academic health care economists and representatives of the health policy community exchanged ideas and perspectives.
  • The authors received comments and suggestions from participants, which they used to revise the papers for publication in the spring 2000 issue of the Journal of Economic Perspectives.

Approximately 20,000 individual and 5,000 institutional subscribers received the spring 2000 issue of the Journal of Economic Perspectives. The articles prepared for the symposium are also available to members on the American Economic Association's website.