Abstract

Despite Medicare's success as a social program, its future is in question because of the program's enormous costs. Because the issue of Medicare reform has been forced upon us at this juncture by a crisis of finance rather than by the long-standing inequities in the present system of paying for the health care of the elderly, questions about how best to secure its fiscal integrity have seized the attention of the public. Yet, such questions are hard to contain; they force an examination of broader and more fundamental issues. In this article, we examine the validity of the ultimate moral and social rationales for continuing Medicare in something approximating its present form; the legitimacy of a social entitlement program that is age- rather than means-based; the implications for the future of health care reform if significant changes were to be made in the Medicare program and its underlying rationale; and the possibility that changes in that program may jeopardize the chances for a more rational, just, and systematic approach to the provision of health care to all Americans.

KIE:

Bayer and Callahan examine the ultimate moral and social rationales for continuing Medicare as an entitlement program that is age- rather than means-based. They argue that, in its universalistic incorporation of all the elderly, Medicare "represents a unique communal expression of social solidarity. It is the one social program that incorporates a vision of health care as a matter of social right and it preserves, if in a stunted form, a vision of a more general social commitment to meeting health care needs on grounds other than relative economic advantage." The authors conclude that Medicare, established as a first step in a national health insurance plan, now also assumes a symbolic function and that changes toward privatization may jeopardize the chance for a more rational, just, and systematic approach to health care access for all Americans.