Health of the Elderly: Policy Issues and Challenges

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Abstract
Prologue: Congress is consumed in its health policy deliberations with an overriding concern: reducing the federal government's mas- sive budget deficit. Within this policy framework, Medicare is a tempting target for the budget-cutters; the emphasis is on freezing provider payments and increasing beneficiary cost-sharing. In this essay, Dorothy Rice and Carroll Estes suggest that given the chang- ing composition of the elderly population-it is growing older and, in its totality, larger-the time has come when Congress should consider not simply spending reductions but the very structure of Medicare itself The authors argue that such exploration is necessary because the medical care needs of the elderly are chang- ing along with the complexion of this age group. As more people live longer, chronic diseases afflict more of them. Medicare is essentially a health insurance plan for acute illness. Very few of its resources finance chronic care Rice and Estes are well equipped to discuss this policy problem. For seven years before her retirement from government in 1981, Rice directed the National Center for Health Statistics. During her stewardship at the center, Rice was internationally recognized as the key architect of the National Health Expenditure Survey. She also developed the meth- odology for the government's Cost of Illness Survey. At present, Rice is a professor at the University of California-San Francisco's School of Nursing. Estes is professor of sociology and director, Aging Health Policy Center, at the University of California-San Franciso and author of the 1979 book, The Aging Enterprise. She has been involved in aging policy and program issues for almost two decades as a scholar conducting research and teaching, a state commissioner on aging, a Gerontological Society officer, and a consultant to the U.S. Senate Special Committee on Aging.

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