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Medicare at 50 — Origins and Evolution

Comments; 1) the author does not emphasize that Medicare in its current state is the most efficiently run insurance program in the country, 2) the author does not mention as cost-saving measures either the problems of malpractice reform or medical school debt, and 3) most relevant to HCAO, if there were a national single-payer health care system paid for by combination of income tax and VAT(ie ongoing sources of revenue), there would be no worry about depletion of the Medicare fund. 
Jerry Robbins MD, Newport

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Health Policy Report, Mary Beth Hamel, M.D., M.P.H., Editor
David Blumenthal, M.D., M.P.P., Karen Davis, Ph.D., and Stuart Guterman, M.A.
N Engl J Med 2015
; 372:479-486January 29, 2015DOI: 10.1056/NEJMhpr1411701

Many Americans have never known a world without Medicare. For 50 years, it has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses. However, as popular as Medicare has become, Congress created the program only after a long and deeply ideological struggle that still reverberates in continuing debates about its future. Nor was the Medicare program that was signed into law by President Lyndon B. Johnson on July 30, 1965, identical to the program we know today. As we mark the beginning of Medicare's 50th anniversary year, this first report in a two-part series recounts the history of this remarkable health care initiative and explains how it came to be, what it has accomplished, and how it has evolved over the past five decades. In the second report in the series, we will describe the ongoing challenges of the program and discuss proposals to address them.

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Part 2: Medicare at 50 — Moving Forward

David Blumenthal, M.D., M.P.P., Karen Davis, Ph.D., and Stuart Guterman, M.A.
N Engl J Med 2015; 372:671-677February 12, 2015DOI: 10.1056/NEJMhpr1414856

As Medicare enters its 50th year, this popular federal program faces profound challenges to its effectiveness and sustainability in future decades. In this report, we review these problems, building on the issues raised in our earlier article.1 We also review several options to strengthen the program and enhance its viability.

Critical Changes Facing Medicare
Rising Expenditures

Perhaps the most important challenge facing Medicare is the prospect of increasing expenditures, driven in large part by demographic trends. As the U.S. population ages, the number of people who are eligible for Medicare benefits will grow, from 52.3 million in 2013 to 81.8 million in 2030.2 From 2009 through 2013, Medicare spending per beneficiary increased at a historically low annual rate of 1.0% in nominal dollars and actually decreased in real terms (accounting for inflation). Over the next decade, slow growth in Medicare spending per beneficiary is expected to continue, but because of substantial increases in the number of beneficiaries, the growth in total program spending will outpace that in the overall economy (Figure 1 Figure 1Projected Annual Growth Rates for Total Medicare Spending, as Compared with the Gross Domestic Product (GDP) and Medicare Enrollment, 2013–2023.). Total Medicare spending is expected to increase from 3.0% of the nation's gross domestic product (GDP) in 2013 to 3.8% in 2030, and the program's share of the federal budget is expected to increase from 14.4% to 15.8%.3 These fiscal trends will create continuing pressure to reform the program.

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