Medicare Matters

“One of the great leaders of our time in American medicine tackles one of the great health-care issues of our generation: the design, fate, and principles of Medicare as a system. Care for our aging population and coverage through Medicare provide key testing grounds for our nation’s moral and technical capacity to extend health and relieve suffering. Dr. Cassel is unique in her ability to bridge the worlds of clinical science, health-care policy, and social ethics as she helps us think through how best to meet that test. This book is a welcome guide and a clear charter for a nation that cares—or ought to care—deeply about addressing the needs of its aging population.”—Donald M. Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement

Savvy, comprehensive, and authoritative, this book, written by a physician with more than thirty years experience caring for elderly patients, assesses the current state and the future prospects of Medicare, perhaps the most influential health-insurance program of our time. Christine K. Cassel draws upon the latest developments in science and medicine in a sweeping analysis of Medicare s social, demographic, institutional, political, and policy contexts. Writing in accessible language, using case studies to illustrate how policies translate to everyday lives, and applying lessons from the practice of geriatric medicine, Cassel makes a powerful argument for reforming and modernizing Medicare. She offers a new vision of what healthy aging could be and delineates what is needed to realize this vision, including changes in the medical sector, in the policy arena, and in our cultural beliefs about aging. Cassel sheds light on a wide range of issues pertaining to Medicare, including debates about coverage and the looming deficit in the Medicare trust fund. Perhaps the most controversial issue she addresses is the challenge of rationing some kinds of care. Anchoring her discussion of Medicare in the idea that care for the elderly represents a social contract between government and its citizens, Cassel describes both the principles and potential of a progressive approach to geriatric medicine. She further argues that with this approach, we can also address the chronic problems of our larger health-care system and provide all Americans, no matter what their age, with high-quality and affordable medical care.

Savvy, comprehensive, and authoritative, this book, written by a physician with more than thirty years' experience caring for elderly patients, assesses the current state and the future prospects of Medicare, perhaps the most influential health care program of our time.

Roughly 40 million Americans have no health insurance, private or public, and the number has grown steadily over the past 25 years. Who are these children, women, and men, and why do they lack coverage for essential health care services? How does the system of insurance coverage in the U.S. operate, and where does it fail? The first of six Institute of Medicine reports that will examine in detail the consequences of having a large uninsured population, Coverage Matters: Insurance and Health Care, explores the myths and realities of who is uninsured, identifies social, economic, and policy factors that contribute to the situation, and describes the likelihood faced by members of various population groups of being uninsured. It serves as a guide to a broad range of issues related to the lack of insurance coverage in America and provides background data of use to policy makers and health services researchers.