There is a "wide gap" between financial experts and the public at large on the issue of Medicare's financial state, according to the New England Journal of Medicine.
As an estimated 20 million more Americans enroll in Medicare over the next decade and fiscal hawks warn of unsustainable costs, Medicare spending growth is actually slowing, as it has during the past 5 years. Yet most of the public is either unaware or believes otherwise, the NEJM found in a review of six surveys.
About six in ten Americans believe that Medicare spending is rising faster than it was five years ago, even as just between 10 percent and 36 percent support reductions in Medicare spending as a solution to the federal budget deficit.
"This has not changed significantly since 1993, when 19 percent of respondents were found to support Medicare spending cuts in order to reduce the federal deficit," wrote Robert J. Blendon and John M. Benson, professors at the Harvard School of Public Health.
"This lack of support may relate to beliefs that might not be factually correct," they wrote. Even as Medicare remains the third largest item in the federal budget, "many Americans are unaware that it is one of the largest budget items" and most do not see Medicare as a major contributor to the deficit. In surveys, just over half of those polled correctly reported Medicare as among the largest federal expenditures, while about one-third said they think it's a major contributor to the deficit.
Blendon and Benson link that sentiment to other survey data showing a majority of Americans thinking that Medicare recipients have largely prepaid for the costs of their healthcare through lifetime payroll taxes and premiums.
That's as the estimated average Medicare beneficiary pays about one dollar for every three dollars of healthcare used -- a reason why Medicare does need a long-term fix -- and as Medicare remains widely popular.
Nearly 72 percent of Americans of all ages, and almost 90 percent of seniors, have a favorable opinion of Medicare, which turns 50 years old in 2015, although many think it could be better -- about 60 percent of the public and 80 percent of seniors think the program currently works well.
Most of those polled in the surveys examined by Blendon and Benson see Medicare already withholding treatments to save money. About 60 percent believe treatment is withheld or rationed at least somewhat often, and about the same proportion think that access to Medicare-covered medical and hospital care is a bigger problem than over-treatment and unnecessary care.
In some ways, Medicare encounters the same public perceptions as most insurance. "Although Medicare is popular, it is not seen as better run than private insurance plans, nor is it seen as particularly different from private coverage with respect to quality of care or access to physician care," Blendon and Benson write.
All of which paints a picture of American seniors as mostly and moderately satisfied health plan members, at a time when Medicare is actually changing, through accountable care policies -- and when more politicians are calling for more drastic changes than they have in the past, such as expanded cost-sharing.
Congress passing drastic Medicare changes is unlikely, Blendon and Benson write, in part because the only age group with a majority supporting Medicare spending reductions is 18-to 29-year-olds, a demographic that represents just over 20 percent of the electorate.
However, Blendon and Benson do have some ideas to guide Medicare understanding and to create an environment for rational policy discussions for Medicare changes.
"It would aid the long-term resolution of these issues if there were a nonpartisan, broad-based public education campaign launched focusing on how Medicare works financially. Second, it would be advantageous if discussions of the financial sustainability of Medicare could be separated from public debates over reducing budget deficits or enacting tax cuts. Until these concerns are better addressed, the gaps in perception are likely to remain."