Health Care of the Disadvantaged: The Elderly

Abstract. This paper explores threats to the maintenance and expansion of public commitment to financing health care for the elderly. Threats come from rising costs that increase financial burdens, especially on low-income elderly; efforts to contain costs that may undermine benefits; and financing initiatives that treat the elderly as the sole revenue source for addressing problems in that age group. A review of these threats provides lessons not only for sustaining and improving health care for the el-derly, but also for policy toward equally or more disadvantaged groups. Relative to other population groups considered in this volume, the elderly are decidedly advantaged. Unlike others, they are the beneficiaries of a universal, pub-licly financed health insurance system-Medicare-that pays their medical bills, regardless of their incomes, and assures them access to mainstream medical care. Furthermore, as a large and organized constituency that votes, the elderly are po-litically advantaged. That advantage is nowhere more evident than in the budget battles of the 1980s, which left Medicare and Social Security relatively unscathed while other social programs were decimated