Congress Examines Tweaking Medicare Although many seniors are happy with the heath coverage they get through Medicare, the program may be unable to cope with the onslaught of 78 million baby boomers who are nearing retirement. Congress is trying to find a way to make Medicare more efficient by creating new systems that reward higher quality care.
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Congress Examines Tweaking Medicare

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Congress Examines Tweaking Medicare

Congress Examines Tweaking Medicare

Congress Examines Tweaking Medicare

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Although many seniors are happy with the heath coverage they get through Medicare, the program may be unable to cope with the onslaught of 78 million baby boomers who are nearing retirement. Congress is trying to find a way to make Medicare more efficient by creating new systems that reward higher quality care.

MADELEINE BRAND, Host:

And NPR's Julie Rovner is back here in the studio now. And now, as you said, she does really, really love her Medicare. And according to polls, a lot of seniors love their Medicare. How typical is she?

ROVNER: Where she is not all that typical is that she's both relatively wealthy for a senior and she has very good retiree coverage from her previous employer. So basically, all of her medical costs are covered, including prescription drugs. She's got a terrific prescription drug plan. Also, as you heard in the piece, she is a very savvy health care consumer. She's figured out how to coordinate all of her own care, how to find doctors that talk to each other, so she doesn't need to undergo duplicate tests or go to doctors, you know, extra times. That's something that Medicare does not automatically do.

BRAND: And a big criticism of the program as a driver of the cost, the increasing costs, right?

ROVNER: That's right. Because Medicare doesn't do that, it's considered, you know, wildly inefficient. And it's one of the things that these health care overhaul bills, now in Congress, are looking to try to fix. You know, current seniors may be happy with their Medicare, but the program is not in good enough financial shape to support the onslaught of 78 million baby boomers who are getting ready to start joining it next year.

BRAND: So tell us more about what Congress wants to do about that.

ROVNER: Well, Congress is trying to find a way to make Medicare more efficient, not necessarily by cutting benefits or raising taxes or cutting payments to doctors or hospital, but by creating new systems of care and payment that would reward higher quality care and pay less for care that wouldn't necessarily lead to better health. Now, that's easy to say but figuring out which kind of care is which is not so easy. And since all of that care is income to health care providers, there's an awful lot of yelling and screaming going on right now, much of which is scaring seniors. So that's what's created all the hubbub.

BRAND: Mm-hmm. And then though some of the hubbub, they do have a point in that, there will be cuts, right?

ROVNER: On the other hand, a lot of people in those plans are getting extra benefits, more than the regular Medicare benefits. They would probably lose some of those extra benefits, things like eye care and foot care, things that Medicare doesn't normally provide. So, yes, some of those then extra benefits could go away.

BRAND: These six bras, for example, that Audrey receives for her prosthesis?

ROVNER: Well, she's not in a Medicare Advantage Plan. But, yeah, maybe that's a place where they could save just a little bit of money without cutting back on necessary care.

BRAND: So the bottom line is that they're trying not to cut back on the necessary core care, but just the extras.

ROVNER: That is the object.

BRAND: Thank you, Julie.

ROVNER: You're welcome.

BRAND: Our series of profiles on people and their health care is called Are You Covered? And it's produced in partnership with Kaiser Health News, a non-profit news service. For more on that series and on health care, you can go to our Web site, npr.org.

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