Book Review

Entitlements and the Elderly: Protecting promises, recognizing reality

N Engl J Med 1996; 335:758September 5, 1996

Article

Entitlements and the Elderly: Protecting promises, recognizing reality
By Marilyn Moon and Janemarie Mulvey. 177 pp. Washington, D.C., Urban Institute Press, 1996. $19.95. ISBN: 0-87766-636-9

In the policy and budget debates of the 1990s, no issue has such political force and significance for millions of Americans as federal entitlements for the elderly. Social Security cash benefits, Medicare health benefits, and Medicaid assistance bolster the economic and health security of older Americans but simultaneously consume a growing share of the federal budget.

This timely and important book tells how these entitlement programs for the elderly operate and explains their strengths and limitations. The authors thoroughly examine the role of these programs, their historical roots, the pressures they face today, and the options for short-term and long-term reform. They provide facts and a context that allow the reader to assess the rhetoric and reality in today's debate.

The authors argue that the futures of Social Security, Medicare, and Medicaid are inevitably intertwined because together these programs provide the benefit structure for elderly Americans. From a researcher's or an analyst's perspective, they are separate programs with different purposes, but they serve a common population and from the perspective of the beneficiaries they are inextricably linked. To formulate policy reforms for the elderly, it is important to look at the programs collectively and acknowledge that they are interrelated. Reform of Social Security and of Medicare affects the same people, and changes in one will inevitably affect the other.

The authors show that there are areas in these entitlement programs where savings can be achieved without compromising goals. They also identify the limitations of such savings in solving the problems of an aging society with growing needs for long-term care. Moderate cuts in Medicare and Social Security spending will not provide the funds needed for meaningful reform of long-term care. Broader solutions and new revenue will be necessary.

Yet, the authors urge readers not to despair — these are serious problems, but there are achievable solutions. There are hard choices, but if we recognize the diversity of the elderly population and build a stable base for the future, the past successes of Social Security, Medicare, and Medicaid will be only a prelude to their future accomplishments.

Diane Rowland, Sc.D.
Henry J. Kaiser Family Foundation, Washington, DC 20005