Public Attitudes on the Future Sustainability of Medicare

Abstract

Background: As Medicare enters its 50th year, numerous programmatic changes aim to improve quality and ensure the program’s financial sustainability. However, the Medicare Board of Trustees projects that the Hospital Insurance Trust Fund for Part A will become insolvent by 2030 due to the cost of caring for an aging population, particularly at end-of-life.

Objectives: We designed a study to evaluate Americans’ attitudes on Medicare’s future. We queried respondents on their opinions on Medicare’s financial future, access to care, rationing end-of-life spending, and their likelihood of choosing private insurance that is cheaper but does not cover more expensive treatments.

Methods: We fielded a nationally-representative survey of American adults through the nonpartisan research firm YouGov (October 1-3, 2014). Using proprietary methodology, a random sample opt-in Internet panel was invited to participate, with gender, age, race, education, region, and voter registration matched to population statistics.

Results: Most respondents believed that Medicare will fall into economic crisis within the next 20 years. Few respondents believed that Medicare should ration spending on end-of-life care, but there were differences by age: people age 45-64 were much less likely to endorse rationing than those age 18-29. Most respondents, especially those over 65, reported that they would rather enroll in a private insurance plan that costs more money but would cover expensive treatments.

Discussion: Our results support previous surveys showing that most Americans are concerned about Medicare’s forthcoming insolvency yet do not support major reductions in Medicare spending. Results suggest that cost-sharing reforms like those implemented through ACA offer viable solutions to Medicare’s insolvency.