Medicare's Midlife Crisis.

• Author: Twight, Charlotte
• Position: Book Review

By Sue A. Blevins Washington, D.C.: Cato Institute, 2001. Pp. x, 136. $16.95 cloth, $8.95 paper.

This valuable book draws together key aspects of the Medicare story seldom combined in a single volume. Sue Blevins (R.N., M.P.H., M.S.), president of the Institute for Health Freedom, describes Medicare's key characteristics, analyzes its consequences for current and future retirees, outlines the program's historical evolution, and formulates an agenda for reform. Medicare's "midlife crisis" includes, among other things, the inexorable rise in Medicare spending, the beneficiaries' ever-rising out-of-pocket medical costs, the reduction in the number of taxpaying workers per Medicare beneficiary because of the retirement of the "baby-boom" generation, the threat to medical privacy associated with efforts to reduce Medicare fraud, and Medicare's impending bankruptcy. Blevins's concern is what needs to be done to remedy that midlife crisis.

At one level, the book is a primer on what Medicare does to retirees, explaining the program's fundamentals in clear and sometimes dramatic ways. It opens with the true story of a man who, nearing age sixty-five, went to sign up for his Social Security benefits with the intention of declining Medicare Part A (hospital insurance) coverage. Although he had paid Medicare taxes throughout his working life, he wanted to decline Medicare Part A benefits in order to retain more control over his medical care and health records. Through this man's experience, Blevins exposes the little-known fact that the federal government now confiscates the Social Security benefits of anyone who declines Medicare Part A coverage, in effect making that coverage mandatory and thus eliminating meaningful choice in hospital insurance for all but the wealthiest retirees. Blevins also explains the other parts of Medicare, including Part B's supplemental medical insurance and Part C's Medicare + Choice program, along with the different funding sources involved. Traditionally unspoken truths--that Medicare does not provide coverage for catastrophic medical expenses, that retirees have no legally binding contractual fight to their Medicare benefits, and that Medicare is compulsory rather than voluntary--are starkly set forth.

Blevins then examines the early historical context that set the stage for Medicare, focusing on efforts between the late 1800s and the 1950s to institutionalize compulsory national health insurance both around the world...