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F R O M  T H E  E D I T O R 

26 September 2005  
  

Medicare: Identifying The 
Challenges That Lie Ahead

Over its almost twenty-five years of publication, Health Affairs has become a principal vehicle for translating health services research into information that health policymakers and their countless pursuers can use as they work their will on the issues of the day. This set of papers is a prime example of this pattern; it sets out to predict the medical costs and health status of the disabled and elderly into the distant future, thus identifying critical challenges that lie ahead for Medicare. Although policymakers are turning a blind eye to many of these challenges, they will one day be forced to confront the growing gap between the program’s expected expenditures and its available revenue. Generally, health spending has been outstripping the gross domestic product by about 3 percent per year in recent decades. Unless there are dramatic changes in Medicare, if not the entire system, this differential might only grow as the baby-boom generation moves toward retirement and the proportion of active workers who will pay for their care diminishes. But perhaps even more important is the rapid growth of use of services by disabled and elderly beneficiaries who rely on them.

Dana Goldman, who directs the RAND Program on Health Economics, supervised the development of these papers. Goldman is part of a RAND Health staff that includes some 170 experts, many of whom are nationally recognized, and he was named Young Investigator of the Year by AcademyHealth in 2002. RAND’s emphasis on health began in the 1960s when policymakers were engaged in a vigorous debate about how health care should be financed. The federal government funded the RAND Health Insurance Experiment, which, to this day, remains the largest health policy study in U.S. history.

The body of work in this package was largely supported by the Centers for Medicare and Medicaid Services (CMS) and the National Institute on Aging (NIA). The NIA, one of the twenty-seven institutes and centers that make up the National Institutes of Health (NIH), has mounted an effective program that supports basic social and behavioral research on the processes of aging. Last year the NIA established six new university-based centers of applied gerontology (bringing the total to ten) that will conduct research on a variety of leading issues, including how to forecast the effects of medical breakthroughs and new ways to use technology to measure and provide care. The NIA and the John A. Hartford Foundation gave support to Health Affairs to publish this series, first as a package of Web Exclusives (www.healthaffairs.org) and then in a printed volume (Vol. 24, Supp. 2).

John K. Iglehart
Founding Editor

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DOI: 10.1377/hlthaff.W5.R4
©2005 Project HOPE–The People-to-People Health Foundation, Inc.