Medicare

When Medicare was established in 1965, many of its supporters believed that insuring persons age sixty-five and over was a precursor to a national system of health insurance. The Medicare program was thought to be just the first piece of legislation towards this end. But instead, Medicare has become the largest public program of health insurance, and universal health insurance is a reality only for older adults and some persons with disabilities.

Although in many ways Medicare has been one of the most successful public programs of the federal government, it has also faced criticism as a result of its rapid expansion. At $222 billion in spending in 2000, it represents about 12 percent of the federal budget. Since the 1980s, it has been a frequent target of efforts to reduce federal spending. Major legislation enacted in 1997 as part of the Balanced Budget Act set in motion the most recent set of changes aimed at slowing the growth of the program. (Legislation enacted in 1998 and 1999 mitigated some of these changes, however.) The implications of an aging society, moreover, are that Medicare will continue to come under scrutiny, and perhaps face major changes in the future.