The Henry J. Kaiser Family Foundation
SOLVENCY OR AFFORDABILITY?
WAYS TO MEASURE MEDICARE’S
FINANCIAL HEALTH
by
Marilyn Moon and Matthew Storeygard
The Urban Institute
Prepared for The Kaiser Family Foundation
March 2002
The Kaiser Family Foundation is an independent, national health philanthropy dedicated to
providing information and analysis on health issues to policymakers, the media, and the general
public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.
The Henry J. Kaiser Family Foundation
SOLVENCY OR AFFORDABILITY?
WAYS TO MEASURE MEDICARE’S
FINANCIAL HEALTH
by
Marilyn Moon and Matthew Storeygard
The Urban Institute
Prepared for The Kaiser Family Foundation
March 2002
The authors wish to thank Krista Dowling for her research assistance on this paper,
and to acknowledge the helpful comments of Robert Reischauer, Lisa Potetz, and
Wendell Primus.
INTRODUCTION
The question of the financial health of the Medicare program is important to the debate
over how the program should change in the future. Are dramatic measures to save costs
necessary? Can resources be found to support a prescription drug benefit? These policy issues
are intimately tied to how we view the program and its financial situation. But there are many
possible ways of examining Medicare’s financial issues, and the choice of which to use is often
made on the basis of politics and spin that a particular measure can create.
This paper examines different ways to look at Medicare’s financial status and the
implications each may hold for the future. A measure can be created that, by definition, will
demonstrate that a major problem exists or that we need not worry about the future. And while
alternative views can emerge on the best or most appropriate measure, some approaches are
misleading and do not contribute constructively to the debate. Moreover, even using the same
measures can result in different characterizations of Medicare. In response to the release of the
2002 Trustees Reports (Board of Trustees, 2002), for example, Medicare was variously called
“unsustainable” and at the same time referred to as a program in “strong financial health.” The
differences arise from attitudes that extend well beyond the choice of measure to what the role of
government should be and to how resources should be shared across generations. Rather than
identifying just one measure, this paper offers a number of alternatives, distinguishing between
issues of “solvency” and “affordability,” offering a broader perspective on the issue of
Medicare’s future.
1
How Medicare is Financed
Before turning to these measures, it is useful to review how the Medicare program is
funded. The two parts of the program have totally different revenue streams. Part A, Hospital
Insurance, is supported mainly by payroll taxes currently set at 1.45 percent each on employers
and employees. Additional revenues come from taxation of Social Security benefits and some
small general revenue transfers. Revenues are held in a trust fund that grows over time and pays
out Part A expenditures on behalf of current beneficiaries. Surplus trust fund dollars are
exchanged for Treasury securities and held as promises to pay benefits for future beneficiaries.
The build up in the Trust Fund is intended to assure individuals that the promises of future
benefits will be kept. Moreover, it is effectively a way to ask current taxpayers (including the
Baby Boom generation which will benefit in the future) to pay more in taxes now than is
necessary to fund current Part A Medicare benefits.
Part B, Supplementary Medical Insurance, is supported by premiums from enrollees
(equal to 25 percent of the costs for elderly beneficiaries) and from general revenues. The law, in
place since Medicare began, requires that general revenues be devoted to Part B in whatever
amounts are needed to pay benefits. Thus, although there is also a Part B trust fund, it is, by law,
kept in balance and hence is usually ignored in solvency discussions.
TRADITIONAL MEASURES OF FINANCIAL HEALTH
A number of basic measures have traditionally been used to provide information on
Medicare’s future financial health. The Medicare Board of Trustees releases three of the most
commonly cited measures each year as part of their annual reports (Board of Trustees, 2002).
2
The first, and most commonly cited, is the date of exhaustion of the Part A Trust Fund.1 A
second popular measure is the ratio of workers to beneficiaries over time. Finally, projected
costs of both Parts A and B as a share of Gross Domestic Product (GDP) are also reported each
year.
Part A Trust Fund Solvency
The Part A Trust Fund was established to ensure that revenues raised for Part A (Hospital
Insurance) were dedicated to expenses of that program. As dedicated revenues, payroll and other
revenue sources that exceed the amount necessary to cover Part A benefits go into the Trust Fund
and collect interest.
Projections of the Medicare Part A trust fund indicate that it will maintain a positive
balance through 2030 (Board of Trustees, 2002). Considered in historical context, the date of
projected insolvency is further into the future than ever before (Figure 1). The trust fund is
expected to grow from its level of $141 billion at the end of 2000 to about $900 billion—or 283
percent of annual Part A expenditures—in 2015 after which the trust fund’s balances will begin
to decline when payroll tax and other receipts are insufficient to cover expenditures.
Like the Social Security Trust Fund, the Part A Trust Fund was designed to assure that
the specified payroll tax contribution would be used specifically for Part A spending, and not, as
some have suggested, to establish a limit on financing over time. Moreover, at the least, the Part
A Trust Fund allows variations in spending to be smoothed out over time, reducing the need to
1
Although there is also a Part B Trust Fund, it serves a much different purpose and is intentionally kept at a
small positive level.
3
revisit the operations of the program each
year. In 1983, additional revenues were
Figure 1
Number of Years Before HI Trust Fund
Projected to be Exhausted
1970
2
1971
added to Social Security to create a
2
1972
4
~
1978
substantial trust fund balance and hence
12
1979
13
1980
14
1981
“pre-fund” some of its benefits, but
Medicare’s Part A Trust Fund was not
10
1982
5
1983
7
1984
7
1985
13
1986
10
1987
adjusted to take on such a role. As a
15
1988
17
~
1990
consequence, this measure of “solvency”
13
1991
14
1992
10
1993
tells us less about the financial health of
the program than many believe. Critics
6
1994
7
1995
7
1996
5
1997
4
1998
of Medicare focused much more on this
10
1999
16
2000
25
2001
trust fund balance in the mid-1990s when
28
2002
28
0
5
10
15
20
25
30
~ Missing Data for Years 1973-1977 and 1989
Source: CRS 1995 and Medicare Trustees Reports.
the date of exhaustion was much closer
(Figure 1), as an early warning of the need for changes in the program.
Today, several criticisms are often leveled at this measure. First, critics have pointed out
that it ignores Part B issues. Hence, there have been efforts to create a combined trust fund
measure (as will be described below). But an even more important issue is whether this measure
of Part A solvency captures the ability to support Part A spending over time. Basing the health
of the program solely on the solvency of the Part A Trust Fund is analogous to individuals
arguing that they cannot pay all their bills because the balance in one of their checking accounts
is too low. The affordability of Medicare is actually a much broader issue than Part A solvency
and should encompass other measures as well.
4
Critics of the Part A Trust Fund solvency measure also argue that it is merely an
accounting fiction and that the assets now reported are not “real.” This is because the actual
dollars that have come in to the Treasury are used for other purposes while the Fund holds
Treasury securities and earns interest on them. But if these dollars are used to pay cash to the
holders of other Treasury securities (that is, to individuals, state, local and foreign governments,
businesses and institutions outside of the federal government) as they come due, the outstanding
debt held by the public will go down and the government’s ability to honor Medicare’s Treasury
Bill holdings when they need to be cashed in will be improved.
When Medicare begins to redeem its securities (because benefit costs begin to exceed
trust fund receipts), the burdens of meeting these obligations will fall on citizens. At that point in
time, general revenue taxes can be raised, spending on other services can be reduced, or the
Treasury can redeem Medicare’s securities by issuing new debt to the public. If the debt owed to
the public is reduced through 2015 using Medicare’s surpluses, then it will be less of a problem
to increase borrowing at a later point in time—representing yet another benefit of paying down
the public debt. But using the surplus to finance current spending (even on Part B) or to cut other
taxes eliminates this advantage.
5
The Worker-to-Beneficiary Ratio
Another measure provided each year in the Trustees’ Report is the ratio of workers
contributing to Medicare at any point in time compared to the number of beneficiaries in the
program. This measure shows that the ratio of younger persons to older ones will decline in the
future given the aging of society. This declining ratio of workers to retirees implies that each
worker will have to bear a larger share of the cost of providing Medicare benefits that are
financed by payroll taxes, if the present “pay-as-you-go” system in which current taxes mainly go
to pay for current benefits) is not changed.
Figure 2
Ratio of Workers to Medicare Beneficiaries (2000-2035)
The numbers as
usually presented are
4.5
4.0
3.90
3.80
3.63
3.5
quite dramatic (Figure 2).
Between 2000 and 2035
3.23
3.0
2.83
2.50
2.5
2.30
2.22
2030
2035
2.0
(several years beyond
when most Baby
Boomers will have
1.5
1.0
0.5
0.0
become eligible for
2000
2005
2010
2015
2020
2025
Source: Urban Institute Analysis of 2002 OASDI and Medicare Trustees Reports.
Medicare), the ratio of workers to beneficiaries will fall from 3.90 to 2.22, and to 2.0 by 2075.2
This change represents a 43 percent decline in the ratio—a fact that is sometimes treated as a 43
percent increase in burdens on workers. Indeed, this is one of the statistics commonly miscited
2
We use 2035 since it will capture much of the dramatic growth in Medicare spending. The uncertainty of
estimates beyond 2035 is such that it may be very misleading to look out until 2075 as is required of the Trustees
Report.
6
by those who fear the program is “unsustainable.” This measure signals the need for more
revenues per worker—a legitimate concern over time. However, it can be faulted for failing to
assess the level of burden relative to ability to pay from each future worker. This measure thus
ignores any improvement in the economic circumstances of workers over time due to per capita
economic growth.
Medicare Spending as a Share of GDP
A third measure, which has long been included in the annual reports but is just now
getting more attention, is the sum of Part A and B spending as a share of GDP. In 2001,
Medicare’s total share was 2.4 percent and is projected to rise to 5.0 percent in 2035. This
represents a doubling of the GDP share. But such an increase should not be a surprise since
health care costs per capita are expected to continue rising, and the number of people covered
will double over the same period. In fact, the share of the population on Medicare is projected to
rise by more than 60 percent.
This measure puts potential costs into the context of the income of the country and in that
sense offers more information than the worker-to-retiree ratio. Moreover, since both Parts A and
B are included, it also provides a broader look into the future than a focus only on Part A
solvency. It is not a very intuitive measure, however, as there is no natural benchmark for what
an appropriate share would be, particularly as the share of the population covered by Medicare
rises over time. In addition, it may not be as helpful in the debate on Medicare’s future because
it does not consider how well off we will be as a society as the level of GDP grows. Some goods
and services, like health care, may appropriately grow as a share of GDP in response to higher
7
living standards.
NEW MEASURES THAT HAVE BEEN PROPOSED
A number of new measures of financial health have been proposed in recent years that
tend to paint a relatively dire picture of Medicare’s future. For example, the co-chairs of the
National Bipartisan Commission on Medicare’s Future suggested a new measure of solvency,
attempting to combine Parts A and B. They proposed to freeze general revenue contributions at a
particular level for purposes of assessing the adequacy of financing for Part B. And more
recently, the Congressional Budget Office (CBO) and the Bush administration have both
implicitly offered measures of financial health that compare spending needs showing only the
revenues specifically earmarked for the program (CBO, 2001 and 2002; Office of the President,
2001 and 2002). In both cases, these alternative measures proposed to handle revenues into
Medicare in a manner at variance with current law.
Limiting General Revenue Contributions
In 1999, some members of the Bipartisan Medicare Commission expressed concern that
the general revenue contribution requirement under Part B represented an open-ended
commitment to Medicare that should be limited. Under current law, general revenues rise as
needed to pay for Part B spending, supplementing beneficiary premiums. The co-chairs of the
Bipartisan Medicare Commission argued, however, that the current approach masks the increased
burden that Part B places on society. Therefore, they sought to establish a limit on general
revenue contributions, analogous to the payroll tax contribution rate that is set by law. The
8
Commission therefore proposed, as part of its recommendations,3 that when general revenues
reached 40 percent of the costs of all Medicare benefits, the contribution would be frozen at that
share unless Congress voted to increase it.
The proposal of
Figure 3
Medicare Solvency Issues Raised by Freezing General
Revenues at 40% of All Revenues
the Medicare
9.0%
Date at Which
General
Revenues =
40%
8.0%
Commission would have
combined Parts A and B
to create a unified
measure of solvency, but
would have constrained
Percentage of GDP
7.0%
Total
Expenditures
Revenue Under
Current Law
6.0%
5.0%
4.0%
3.0%
2.0%
Revenue if General
Revenue
1.0%
2073
2069
2065
2061
2057
2053
2049
2045
2041
2037
2033
2029
2025
2021
2017
2013
2009
2005
revenues that could be
2001
0.0%
Year
used to meet future needs.
Source: Urban Institute Analysis of 2001 OASDI and Medicare Trustees Reports.
Under this approach, if Congress failed to lift the cap, there would be insufficient funds to pay
for current level of benefits beginning in about 2021. Further, as Figure 3 illustrates, the gap
between expenditures and revenues would widen even more in subsequent years and there would
be fewer resources available to fund Medicare benefits in the future.4
Thus, the Medicare Commission proposed both a new measure of solvency and new
constraints on revenues. While a unified measure of solvency could be advantageous in taking
3
A majority of commission members agreed to a set of recommendations, but the number fell short of the
level established in legislation to formally transmit their recommendations to the President and Congress. Thus,
while there was no formal final report, this solvency measure was broadly discussed.
4
Moreover, critics of this approach have expressed concern that this would change the entitlement nature of
the program by making it subject to annual appropriations.
9
into account both portions of Medicare spending, it is unclear how or why the limit on general
revenues was set at 40 percent, rather than a higher or lower share. This apparently arbitrary
restriction obscures an important policy debate about the affordability of Medicare.5
This approach puts the cart before the horse by locking in general revenue’s share of
contribution to Medicare in the guise of a measurement change. It also shortchanges the debate
on what revenue sources to use for Medicare in the future. Each source has its own advantages
and disadvantages. For example, the payroll tax, which still represents the largest share of
funding for Medicare, is a simple tax to administer and easy for individuals to understand. It is
also directly tied to the Medicare program, stressing that this is a social insurance program. But,
payroll taxes tend to be regressive, meaning that their burdens fall heavily on low-wage workers.
And critics often argue that such taxes discourage employers from expanding their workforce.
On the other hand, general revenue contributions tend to be more progressive than other taxes,
reducing low-income burdens. They grow faster than payroll taxes over time, doing a better job
of keeping up with the costs of care. Further, retirees as well as workers pay income taxes which
help to spread the burden of Medicare across workers and beneficiaries. However, this revenue
source is often criticized because of the complexity of the income tax and individuals’ concerns
about its fairness.
5
Other attempts at finding a way to combine Medicare A and B spending using a “virtual trust fund”
approach have used other potential measures such as freezing the share of GDP that now comes from general
revenues. This is essentially a way to argue that increases in general revenues beyond what could come from
economic growth need to be considered in policy debates. (See for example, Moon, Segal and Weiss, 2000; and
Gluck and Moon, 2000).
10
Beneficiary premiums represent the third major source of funding for the program, thus if
limits are set on general revenues, there would be implications for beneficiaries as well. Future
financing through increased premiums offers a means for asking individuals who benefit to pay
some of the costs of their own care. But, burdens on Medicare beneficiaries for the costs of
health care are already high and will grow over time if, as expected, health care costs rise faster
than their incomes (Maxwell, Moon and Segal, 2001).
Using an explicit limit on general revenue contributions makes the future financial health
of Medicare less secure and fails to reconcile differences between commitments and revenues.
All of these issues need to be addressed when considering the desired balance across revenue
sources; but this discussion should not be confused with decisions about how to measure
solvency or affordability.
Omitting General Revenue Obligations
An even more stringent view of Medicare finances has been put forth by both the Bush
administration in its FY 2003 Budget and by the Congressional Budget Office in its January 2002
Medicare baseline. This relatively new approach to describing Medicare’s financial outlook
omits general revenue sources from the presentation of Medicare revenues and includes only
“dedicated” revenues (payroll taxes and premiums) in comparisons of revenues and costs over
time. As shown in Figure 4, this gives the appearance of a substantially lower revenue stream for
Medicare over time. In its FY 2003 Budget, the Administration refers to the program as being
“in deficit” because dedicated taxes (mainly payroll tax revenues and premiums) are insufficient
to cover current spending. But this is a misrepresentation because general revenue contributions
11
(an explicitly designated
Figure 4
Medicare Solvency Issues Raised by Counting Only
Dedicated Revenues
source of funding under
9.0%
8.0%
current law) are ignored.
The Bush administration
also argues that revenues
from Part A—over and
above current spending
Percentage of GDP
7.0%
6.0%
Total Expenditures
5.0%
4.0%
Current Law Revenues
3.0%
2.0%
Dedicated Revenues
1.0%
2073
2069
2065
2061
2057
2053
2049
2045
2041
2037
2033
2029
2025
2021
2017
2013
2009
on Part A—should be
2005
2001
0.0%
Year
used to finance Part B
Note: The difference between Current Law Revenues and Dedicated Revenues (premiums and payroll taxes) is General Revenue.
Source: 2001 OASDI and Medicare Trustees Reports.
spending in place of general revenues.
The major weakness of omitting general revenues from an overall view of Medicare’s
fiscal health is that it omits a critical funding source to which Medicare is entitled under current
law. It makes Medicare’s situation appear to be much worse than it is both now and in the future.
Since general revenues have been a major source of support for the program from the beginning,
it is misleading to simply zero out this component. This may be a legitimate option to debate,
but it is not consistent with current law and skirts the need for a broader discussion of how
funding should be set in the future.
Figure 5 considers the implications of restrictions on general revenue financing by
comparing the amount of revenues that would need to be raised to finance benefits in selected
years through 2035 if general revenues were capped at 40 percent of total spending, or omitted
altogether. This measure effectively examines revenues and spending only in a current year
context, ignoring the Part A Trust Fund and excluding as revenue both interest and principal on
12
the balance in that Trust
Fund. Figure 5 shows
Figure 5
Additional Revenues Needed to Cover Medicare Spending
Under Alternative Restrictions on Current Revenues
3.0%
that, under current law,
2.5%
which includes income
1.9%
2.0%
1.4%
1.5%
from general revenues,
Medicare financing
0.5%
0.5%
remains strong until 2015
0.5%
-0.2% -0.2%
2005
Current Law Funding
pay-as-you go basis. The
0.6%
0.0% 0.0%
0.0%
-0.5%
1.1%
1.0%
1.0%
even when viewed on this
2.8%
Additional Revenues as a Percent of GDP
2015
2025
Freezing General Revenue at 40% of Total
2035
Dedicated Revenues Only
Source: Urban Institute Analysis of 2002 OASDI and Medicare Trustees Reports.
second bar on the chart for each year indicates the gap that remains if the Medicare
Commission’s approach were used; it looks bleaker than current law. If general revenues are not
counted at all (the third bar), by 2035, the program would be substantially out of balance.
ANOTHER WAY TO LOOK AT AFFORDABILITY
Issues of the future affordability of Medicare benefits go well beyond technical
definitions of solvency and even of government spending in general. As our population ages and
the numbers of persons eligible for Medicare swell, these older and disabled persons must get
care somewhere. If no public program provides health care, then individuals and their families
will be responsible for the costs. In such a case, it is likely that the equal access to care that most
older and disabled persons receive under Medicare would deteriorate as those who cannot afford
the best care will be left behind.
If such care remains a high priority, the key question is whether—as a society—we can
13
afford that care and, if so, how it will be financed. Many of those who question the
“sustainability” of the Medicare program are implicitly arguing that as a society we will not be
able to afford to care for our elderly and disabled—or at least not through a public program. In
support of this argument, skeptics usually point to the share of GDP that Medicare will require
and/or the worker-to-beneficiary ratio. The Bush administration’s approach represents more of a
public sector view of affordability, showing big gaps in funding that would be needed to keep the
program going.
Another way to look at affordability is to focus not just on the number of workers but also
on what they will produce. Further, while the share of the pie (GDP) going to Medicare is likely
to rise, if the pie (on a per capita basis) is also much larger, then an increasing share is less of a
burden. Indeed, this has been the justification over the years for increasing Social Security
benefit generosity and adding Medicare to the system. In that way, the higher standards of living
enjoyed by Americans since the end of World War II have been shared with retirees. If the future
also leads to increased national well-being, such a sharing of resources may prove to be
affordable. Hence, we offer a new way to examine affordability by focusing on whether
taxpayers of the future will be better off even after they pay higher amounts for Medicare. This
measure seeks to examine whether, as a society, we can afford such care for this population.
First, we compute per worker GDP amounts over time. Per worker GDP is a measure of
the nation’s output of goods and services divided across the working population. While these
resources will be shared with others as well, this ties Medicare’s burden to workers since they
pay for the bulk of support for the program. Second, we subtract the Medicare burden that each
worker will be expected to bear under current law. Per worker GDP—even after adjusting for
14
inflation—rises substantially, from $67,000 per worker in 2000 to over $105,000 in 2035 (in
2002 dollars).6 This is an increase of 56.7 percent in per worker output.
The burdens from Medicare spending are projected to rise at a faster rate because both
numbers of beneficiaries and their inflation-adjusted spending will rise over time. Indeed, as
discussed earlier, the share of GDP going toward Medicare will rise. But because per worker
GDP is a much larger dollar amount than Medicare burdens, the reduction in well-being that this
entails for workers is modest.
To calculate this per worker burden from Medicare, several adjustments are necessary.
First, each worker will bear an increasing share of Medicare over time because of the change in
the ratio of workers to retirees. Further, per capita Medicare costs are expected to rise by 102
percent in real terms by 2035, also increasing the real dollar burden on workers. But not all of
Medicare’s costs are borne by workers. Thus, we adjust these costs downward by the
contributions that will be made by beneficiaries themselves. The Part B premium accounts for
about 10 percent of Medicare’s costs. In addition, beneficiaries make further contributions
because some of the taxation of Social Security benefits goes into Part A and older and disabled
persons also pay income taxes that help support Part B. Thus, we net out those costs.
The resulting real per worker burden is estimated to rise from $1,315 in 2000 to $4,219 in
2035 (in 2002 dollars). As shown in Figure 6, the bar graph indicates per worker GDP in
inflation-adjusted dollars, and the line graph indicates how much would be left for workers after
accounting for the Medicare burden. From 2000 to 2035, the increase in net (after subtracting
6
We use the intermediate projections from the 2002 Trustees Report, which assumes a 1.1 percent real
growth in per worker wages each year. Over the past 50 years, productivity has been higher than this amount,
averaging over 1.5 percent per year.
15
Medicare) per worker resources would be 53.8 percent as compared to the 57.0 percent increase
in per worker GDP.
Figure 6
Impact of Medicare Burden on Workers, 2000-2035
(in 2002 dollars)
$120,000
$105,982
$99,318
$100,000
$93,147
$80,000
$67,473
$60,000
$66,158
$72,313
$70,870
$77,348
$75,762
$82,528
$80,577
$87,460
$85,071
$90,205
That is, workers would
still be substantially better
off than today, even after
$101,763
$95,728
paying the full projected
costs of Medicare.7 The
$40,000
pie will indeed have
$20,000
gotten larger. There will,
$0
2000
2005
Per Worker GDP
2010
2015
2020
2025
2030
2035
of course, be other
Per Worker GDP - Adjusted Medicare Burden
demands on these
Source: Urban Institute Analysis of 2002 OASDI and Medicare Trustees Reports.
resources as well, but this approach puts demands from Medicare into a broader perspective. We
prefer this measure for examining affordability because it takes into account Parts A and B of
Medicare, and it puts the issue of the burdens of the program into a per worker context that is
likely to be more meaningful to individuals looking into the future.
CONCLUSIONS
Policy debate on an issue as important as Medicare’s future will always offer a confusing
array of numbers to prove various points. And most of the measures described above can
appropriately be used at various times. But it is important to match the measure with the
7
This trend has been in place since 1975 as well, with Medicare burdens growing but not by enough to slow
the growth in per worker resources by very much. In addition, the results would be similar if we were to add Social
Security to this calculation as well.
16
question. Part A solvency issues are important, but only speak to a part of the issues affecting
Medicare’s future. If the issue is Medicare’s current financial health, it is inappropriate to
exclude general revenues from the assessment since these revenues represent a legitimate source
of Medicare funding as established in statute. Moreover, by making the program appear to be in
worse shape than it really is, Medicare is vulnerable to radical restructuring that could leave
future beneficiaries out in the cold.
Changes in Medicare will be needed over time to meet higher costs, but both the needs
and our ability to pay should be examined carefully. The appropriate question to ask is whether,
as a society, we will be able to afford Medicare without an inordinate burden on workers or
taxpayers. A new and more comprehensive measure of net per worker wealth offered here
suggests that the answer is certainly yes once even modest estimates of productivity growth over
time are taken into account. The greatest challenge will be for society to decide whether it is
willing to share these costs.
17
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Crippen, Dan. 2001. “Medicare Solvency.” Testimony before the Committee on Ways and
Means, U.S. Senate 107th Congress 1st Session, March.
Maxwell, Stephanie, Marilyn Moon and Misha Segal. 2001. Growth in Medicare Out-of-Pocket
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Moon, Marilyn, and Michael Gluck. 2000. Financing Medicare’s Future. Washington D.C.:
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Moon, Marilyn, Misha Segal and Randall Weiss. 2000/2001. “A Moving Target: Financing
Medicare for the Future.” Inquiry, vol. 37, no. 4.
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