Taking medicare seriously

In this article, Professor Kaplan questions the validity of Professor Epstein's attack on the Medicare system. Professor Kaplan agrees with some of Professor Epstein's observations, such as the claim that Medicare needs serious reform, and the concern that, like many other government programs, Medicare started small but grew rather large. However, Kaplan argues that Epstein sometimes misses the point. For example, Kaplan responds to Epstein's claim that Medicare gets less efficient as it grows by asserting that the better point is that Medicare is more efficient than its private sector counterparts. But Kaplan's primary concern is his suspicion that many of Epstein's criticisms stem from a "reflexive antipathy" to governmental programs. Thus, Kaplan argues, Epstein fails to account for the need for Medicare in this country and fails to propose responsive reforms. Kaplan then analyzes current Medicare reforms such as Medical Savings Accounts, increasing the eligibility age, and means testing. He finds problems with each and argues that reform efforts should be focused instead on three areas: prescription drugs, nursing-home care, and preventive care. He concludes by asserting that the Medicare system is a fragmented patchwork that confuses those it serves. Any reform, Kaplan argues, must include an effort to make the rules simpler and more cohesive.