Zeitschrift für klinische und experimentelle Dermatologieforschung
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Reducing National Health Care Expenditures for Aging Populations

Richard L. Kaplans

Most developed and many developing countries are characterized by aging populations due to diminished birth rates and improved health care that has enabled people to live longer. This phenomenon has exceptionally varied societal implications pertaining to everything from economic growth to political voting patterns, but one of the most significant implications involves the cost of health care services provided to older citizens. The combination of a rising number of older persons and the development of new and more expensive treatment regimens produces an increasing health care costs. This paper examines how the U.S. health care program for older Americans known as Medicare has tried to reduce the cost of medical expenditures from both an individual and a public policy perspective. The specific strategies considered include: (1) raising the program’s minimum age eligibility, (2) reducing the range of covered benefits, (3) increasing costsharing parameters such as deductibles and co-payments, (4) limiting benefits for higher-income beneficiaries, (5) lowering prices paid to health care providers, and (6) rationing health care services on the basis of chronological age. This inquiry has particular salience in 2020 as the current presidential election campaign features prominent proposals, typically denominated “Medicare for All,” that would create the sort of nationwide, single-payer health care financing mechanism that many other developed countries already have. This issue is also pertinent to countries that have such a mechanism in place as they grapple with aging populations and concomitant demands for ever-increasing medical interventions.