Taking Medicare seriously

In this article, Professor Kaplan questions the validity of Professor Epste in's attack on the Medicare system. Professor Kaplan agrees with some of Pr ofessor Epstein's observations, such as the claim that Medicare needs serio us reform, and the concern that, like many other government programs, Medic are started small but grew rather large. However, Kaplan argues that Epstei n sometimes misses the point. For example, Kaplan responds to Epstein's cla im that Medicare gets less efficient as it grows by asserting that the bett er point is that Medicare is more efficient than its private sector counter parts. But Kaplan's primary concern is his suspicion that many of Epstein's criticisms stem from a "reflexive antipathy" to governmental programs. Thu s, Kaplan argues, Epstein fails to account for the need for Medicare in thi s country and fails to propose responsive reforms. Kaplan then analyzes current Medicare reforms such as Medical Savings Accou nts, increasing the eligibility age, and means testing. He finds problems w ith each and argues that reform efforts should be focused instead on three areas: prescription drugs, nursing-home care, and preventive care. He concl udes by asserting that the Medicare system is a fragmented patchwork that c onfuses those it serves. Any reform, Kaplan argues, must include an effort to make the rules simpler and more cohesive.