Bayer R, Callahan D
J Health Polit Policy Law. 1985 Fall;10(3):533-47. doi: 10.1215/03616878-10-3-533.
Despite Medicare's success as a social program, its future is in question because of the program's enormous costs. Because the issue of Medicare reform has been forced upon us at this juncture by a crisis of finance rather than by the long-standing inequities in the present system of paying for the health care of the elderly, questions about how best to secure its fiscal integrity have seized the attention of the public. Yet, such questions are hard to contain; they force an examination of broader and more fundamental issues. In this article, we examine the validity of the ultimate moral and social rationales for continuing Medicare in something approximating its present form; the legitimacy of a social entitlement program that is age- rather than means-based; the implications for the future of health care reform if significant changes were to be made in the Medicare program and its underlying rationale; and the possibility that changes in that program may jeopardize the chances for a more rational, just, and systematic approach to the provision of health care to all Americans.
尽管医疗保险作为一项社会计划取得了成功，但其未来却因该计划的巨额成本而受到质疑。由于医疗保险改革问题是在此时因财政危机而非现行老年人医疗保健支付体系中长期存在的不公平现象而被强加给我们的，关于如何最好地确保其财政健全性的问题已引起公众关注。然而，这些问题难以局限于此；它们促使人们审视更广泛、更根本的问题。在本文中，我们将探讨以近似当前形式继续实施医疗保险的最终道德和社会基本原理的有效性；一个基于年龄而非经济状况的社会福利计划的合法性；如果医疗保险计划及其基本原理发生重大变化，对未来医疗保健改革的影响；以及该计划的变化可能危及为所有美国人提供更合理、公正和系统的医疗保健服务机会的可能性。
