Bioethics for Breakfast: Controlling Medicare Costs: What Are the Options? What Is Fair?

bioethics-for-breakfastLeonard M. Fleck, PhD, and Tom Marks presented at Thursday morning’s Bioethics for Breakfast event, offering views on the topic, “Controlling Medicare Costs: What Are the Options? What Is Fair?”

An October 2013 Health Affairs article projected that total Medicare spending for the next ten-year period would be close to $8.5 trillion. This is obviously a large portion of federal spending over that period of time and a substantial contributor to the federal deficit problem. What should be done to address this issue fairly and compassionately?

In the discussion, speakers and attendees explored a range of options for controlling future Medicare costs.  These included raising the age of eligibility for Medicare, raising the Medicare payroll tax by one percentage point, raising Medicare premiums and co-payments for beneficiaries, reducing payments to providers, bargaining more effectively with pharmaceutical companies, and endorsing a “defined benefit” approach to Medicare (often referred to as the Ryan plan).  It was noted that some of these options are seriously deficient from the perspective of health care justice.  It was also noted that Medicare reform must include both revenue enhancement and substantial cost control in order to keep Medicare sustainable far into the future.  It was concluded that no one policy option will magically fix Medicare, that multiple policies will need to be adopted, some of which will be morally and politically painful.  The key to achieving this will be honest, rational, and mutually respectful public conversation, as opposed to often vicious and disingenuous rhetoric that has been the currency of debate thus far.

Leonard M. Fleck, Ph.D.
Leonard M. Fleck is a Professor of Philosophy and Medical Ethics at the Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University. He is the author of Just Caring: Health Care Rationing and Democratic Deliberation (Oxford University Press, 2009).

Tom Marks
Tom Marks is a principal from the Lansing, Michigan office of Health Management Associates and is one of the firm’s leading experts in public reimbursement policy. Since joining HMA in February 2013, Tom has worked extensively with hospitals and health systems around the country on payment reform and other financial matters. Tom spent more than 20 years at the University of Michigan Health System in various financial leadership roles.

About Bioethics for Breakfast:

In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.